Provider Demographics
NPI:1598845315
Name:PATEL, JAYANTILAL C (MD)
Entity Type:Individual
Prefix:
First Name:JAYANTILAL
Middle Name:C
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 1:1451 ROUTE 88 WEST
Mailing Address - Street 2:OLYMPIC GARDEN SUITE 9
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2371
Mailing Address - Country:US
Mailing Address - Phone:732-840-3500
Mailing Address - Fax:732-840-7538
Practice Address - Street 1:1451 ROUTE 88
Practice Address - Street 2:OLYMPIC GARDEN SUITE 9
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2371
Practice Address - Country:US
Practice Address - Phone:732-840-3500
Practice Address - Fax:732-840-7538
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31733207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4686501Medicaid
1C595556Medicare PIN
D19935Medicare UPIN