Provider Demographics
NPI:1417949975
Name:PATEL, DIPTIKA (MD)
Entity Type:Individual
Prefix:
First Name:DIPTIKA
Middle Name:
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 1:200 PERRINE RD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2842
Mailing Address - Country:US
Mailing Address - Phone:732-727-4780
Mailing Address - Fax:732-727-1989
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE 227
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-727-4780
Practice Address - Fax:732-727-1989
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03959700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3207005Medicaid
NJD96734Medicare UPIN
NJ3207005Medicaid