Provider Demographics
NPI:1013983998
Name:PATEL, MANISH S (MD)
Entity type:Individual
Prefix:DR
First Name:MANISH
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:125 PATERSON ST
Mailing Address - Street 2:ROOM 2330
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1962
Mailing Address - Country:US
Mailing Address - Phone:732-235-6539
Mailing Address - Fax:732-235-7144
Practice Address - Street 1:125 PATERSON ST
Practice Address - Street 2:ROOM 2330
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-6539
Practice Address - Fax:732-235-7144
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08332100207R00000X
IL036116200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00758839OtherR R MCR
VAPAROtherCORVEL COR CARE
VA188794OtherATHEM BC/BS VA/HK
VAPAROtherMULTI PLAN
VAPAROtherMID-ATLANTIC VICARE
NC5902100Medicaid
VA-028OtherCHAMPUS/TRICARE
VA010202906Medicaid
NJ0169820Medicaid
NC5902100OtherBC/BS NC
VAPAROtherMULTI PLAN
VAPAROtherCORVEL COR CARE
NC5902100OtherBC/BS NC
NJ129159BB4Medicare PIN