Provider Demographics
NPI:1598740292
Name:PATEL, MUKESH MAGANBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:MAGANBHAI
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 1:1628 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2841
Mailing Address - Country:US
Mailing Address - Phone:732-205-9070
Mailing Address - Fax:732-205-9165
Practice Address - Street 1:1628 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2841
Practice Address - Country:US
Practice Address - Phone:732-205-9070
Practice Address - Fax:732-205-9165
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05531500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ52306Medicaid
NJ52306Medicaid
NJPA727108Medicare ID - Type Unspecified