Provider Demographics
NPI:1588659296
Name:PATEL, SAMIR G (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6 SANIBEL CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5817
Mailing Address - Country:US
Mailing Address - Phone:732-416-0065
Mailing Address - Fax:732-416-0053
Practice Address - Street 1:407 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1739
Practice Address - Country:US
Practice Address - Phone:732-416-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06726200207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7897201Medicaid
NJ7897201Medicaid
NJ024305Medicare ID - Type Unspecified