Provider Demographics
NPI:1891818530
Name:PATEL, ANJALI D (DO)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3638
Mailing Address - Country:US
Mailing Address - Phone:973-779-7354
Mailing Address - Fax:973-779-7385
Practice Address - Street 1:1060 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3638
Practice Address - Country:US
Practice Address - Phone:973-779-7354
Practice Address - Fax:973-779-7385
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT010795207L00000X
NJ25MB08416900207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB08416900OtherSTATE LICENSE
NJ0178233Medicaid
NJ25MB08416900OtherSTATE LICENSE