Provider Demographics
NPI:1275583130
Name:PATEL, SURESH I (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34-36 PROGESS ST
Mailing Address - Street 2:TWIN PLAZA SUITE A-1
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:908-561-5700
Mailing Address - Fax:908-561-5840
Practice Address - Street 1:34-36 PROGESS ST
Practice Address - Street 2:TWIN PLAZA SUITE A-1
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:908-561-5700
Practice Address - Fax:908-561-5840
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05307100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1800001Medicaid
NJ1800001Medicaid