Provider Demographics
NPI:1326019175
Name:PATEL, MANISH A (DO)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1702
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:
Practice Address - Street 1:1900 BURLINGTON MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4722
Practice Address - Country:US
Practice Address - Phone:609-387-0325
Practice Address - Fax:609-387-0149
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07470900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0043834Medicaid
083099CO4Medicare ID - Type Unspecified
I16050Medicare UPIN