Provider Demographics
NPI:1881818086
Name:PATEL, PURUSHOTTAM CHUNILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:PURUSHOTTAM
Middle Name:CHUNILAL
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 1:8 FROST AVE W
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3165
Mailing Address - Country:US
Mailing Address - Phone:732-321-1599
Mailing Address - Fax:732-321-5343
Practice Address - Street 1:8 FROST AVE W
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3165
Practice Address - Country:US
Practice Address - Phone:732-321-1599
Practice Address - Fax:732-321-5343
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA028237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD99911Medicare UPIN