Provider Demographics
NPI:1639256696
Name:PATEL, JAY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:777 ROUTE 70 EAST
Mailing Address - Street 2:SUITE G-101
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2345
Mailing Address - Country:US
Mailing Address - Phone:856-983-9939
Mailing Address - Fax:856-983-9936
Practice Address - Street 1:777 ROUTE 70 EAST
Practice Address - Street 2:SUITE G-101
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2345
Practice Address - Country:US
Practice Address - Phone:856-983-9939
Practice Address - Fax:856-983-9936
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA67933207Q00000X
NJ25MA06793300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8287104Medicaid
NJ042806Medicare UPIN
NJ8287104Medicaid