Provider Demographics
NPI:1518985332
Name:PATEL, MAYANK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYANK
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAYANK
Other - Middle Name:D
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:659 NEW DOVER RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1912
Mailing Address - Country:US
Mailing Address - Phone:732-382-0344
Mailing Address - Fax:732-382-0340
Practice Address - Street 1:659 NEW DOVER RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1912
Practice Address - Country:US
Practice Address - Phone:732-382-0344
Practice Address - Fax:732-382-0340
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04026700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3396801-01Medicaid
NJ3396801-01Medicaid