Provider Demographics
NPI:1407954548
Name:PATEL, SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
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:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-0118
Mailing Address - Country:US
Mailing Address - Phone:908-626-1776
Mailing Address - Fax:908-626-0776
Practice Address - Street 1:266 KING GEORGE RD
Practice Address - Street 2:SUITE D
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5120
Practice Address - Country:US
Practice Address - Phone:908-626-1776
Practice Address - Fax:908-626-0776
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07446700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25321Medicaid
25512OtherUNIVERSITY HEALTH PLAN
60001670OtherHORIZON NJ HEALTH
60001670OtherHORIZON NJ HEALTH
25512OtherUNIVERSITY HEALTH PLAN