Provider Demographics
NPI:1275614646
Name:PATEL, RAJENDRA P
Entity Type:Individual
Prefix:MR
First Name:RAJENDRA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NE
Mailing Address - Zip Code:07112
Mailing Address - Country:US
Mailing Address - Phone:973-926-0191
Mailing Address - Fax:
Practice Address - Street 1:233 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NE
Practice Address - Zip Code:07112
Practice Address - Country:US
Practice Address - Phone:973-926-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00429100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3420205OtherDME
NJ3131149OtherNABP
NJ4407601Medicaid
NJ1276650001Medicare NSC