Provider Demographics
NPI:1962509265
Name:PATEL, JAYESHKUMAR S (MD)
Entity Type:Individual
Prefix:
First Name:JAYESHKUMAR
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:550 SUMMIT AVE
Mailing Address - Street 2:BASEMENT
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2707
Mailing Address - Country:US
Mailing Address - Phone:201-209-1802
Mailing Address - Fax:201-604-7764
Practice Address - Street 1:550 SUMMIT AVE
Practice Address - Street 2:BASEMENT
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2707
Practice Address - Country:US
Practice Address - Phone:201-209-1802
Practice Address - Fax:201-604-7764
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06719700207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8551804Medicaid
NJ044628Medicare PIN