Provider Demographics
NPI:1639112352
Name:PATEL, BHUPENDRA C (MD)
Entity Type:Individual
Prefix:
First Name:BHUPENDRA
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 1:19 ROLLING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4429
Mailing Address - Country:US
Mailing Address - Phone:908-754-9908
Mailing Address - Fax:
Practice Address - Street 1:1200 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07061
Practice Address - Country:US
Practice Address - Phone:908-668-2200
Practice Address - Fax:908-668-6894
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07169000207R00000X
NJMA71690207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0095630Medicaid
NJ098692Medicare ID - Type Unspecified
NJ0095630Medicaid
NJ098692XZMMedicare PIN