Provider Demographics
NPI:1316029804
Name:PATEL, JITENDRA K (MD)
Entity Type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2300 ATLANTIC AVE
Mailing Address - Street 2:#1
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6680
Mailing Address - Country:US
Mailing Address - Phone:609-345-9100
Mailing Address - Fax:609-345-6114
Practice Address - Street 1:2300 ATLANTIC AVE
Practice Address - Street 2:#1
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6680
Practice Address - Country:US
Practice Address - Phone:609-345-9100
Practice Address - Fax:609-345-6114
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7881908Medicaid
NJ002895TT3Medicare PIN
NJ7881908Medicaid