Provider Demographics
NPI:1396817631
Name:PATEL, GITA R (MD)
Entity Type:Individual
Prefix:DR
First Name:GITA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2027
Mailing Address - Country:US
Mailing Address - Phone:908-722-0035
Mailing Address - Fax:908-722-6763
Practice Address - Street 1:31 W SOMERSET ST
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-2027
Practice Address - Country:US
Practice Address - Phone:908-722-0035
Practice Address - Fax:908-722-6763
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04845700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1758501Medicaid
NJ1758501Medicaid
NJ553963Medicare PIN