Provider Demographics
NPI:1750330072
Name:PATEL, DUSHYANT RAMESHCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSHYANT
Middle Name:RAMESHCHANDRA
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 1:12-15 BROADWAY STE B
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2031
Mailing Address - Country:US
Mailing Address - Phone:201-773-6868
Mailing Address - Fax:201-773-6867
Practice Address - Street 1:12-15 BROADWAY STE B
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2031
Practice Address - Country:US
Practice Address - Phone:201-773-6868
Practice Address - Fax:201-773-6867
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07990500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0108872Medicaid
NYI 01408Medicare UPIN
NJ109071WA2Medicare ID - Type Unspecified
NJ0108872Medicaid