Provider Demographics
NPI:1760740617
Name:PATEL, CHANDNI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDNI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:MOB2 PEDIATRIC CARDIOLOGY
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901
Mailing Address - Country:US
Mailing Address - Phone:732-846-2855
Mailing Address - Fax:732-745-4680
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:MOB2 PEDIATRIC CARDIOLOGY
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-846-2855
Practice Address - Fax:732-745-4680
Is Sole Proprietor?:No
Enumeration Date:2012-04-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA106471002080P0202X
CT54107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760740617Medicaid