Provider Demographics
NPI:1770659484
Name:PATEL, JAYA C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYA
Middle Name:C
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 1:2920 EAGLES COURT
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7300
Mailing Address - Country:US
Mailing Address - Phone:856-691-4807
Mailing Address - Fax:856-697-0685
Practice Address - Street 1:1676 LANDIS AVENUE
Practice Address - Street 2:VINELAND DEVELOPMENTAL CENTER
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-696-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4474201Medicaid
NJ636224B1HOtherMEDICARE BILLING ID
NJ636224B1HOtherMEDICARE BILLING ID