Provider Demographics
NPI:1477615110
Name:HIMANSHU A. PATEL. MD. PA
Entity Type:Organization
Organization Name:HIMANSHU A. PATEL. MD. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIMANSHU
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-418-1700
Mailing Address - Street 1:401 RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-3300
Mailing Address - Country:US
Mailing Address - Phone:732-418-1700
Mailing Address - Fax:732-249-9599
Practice Address - Street 1:401 RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-3300
Practice Address - Country:US
Practice Address - Phone:732-418-1700
Practice Address - Fax:732-249-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6867405Medicaid
NJ6867405Medicaid
NJPA849588Medicare ID - Type Unspecified