Provider Demographics
NPI:1629347265
Name:JAYESH V. PATEL DO PA
Entity Type:Organization
Organization Name:JAYESH V. PATEL DO PA
Other - Org Name:JAYESH V. PATEL DO. PA.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:321-269-0059
Mailing Address - Street 1:2175 A CHENEY HWY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6792
Mailing Address - Country:US
Mailing Address - Phone:321-269-0059
Mailing Address - Fax:321-269-9926
Practice Address - Street 1:2175 A CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6792
Practice Address - Country:US
Practice Address - Phone:321-269-0059
Practice Address - Fax:321-269-9926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAYESH V. PATEL DO PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-28
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7701261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254600100Medicaid
FL56756Medicare UPIN
56756Medicare PIN