Provider Demographics
NPI:1134225162
Name:PATEL, DEEPA SAMIR (MD)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:SAMIR
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 1:6 SANIBEL CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5817
Mailing Address - Country:US
Mailing Address - Phone:732-521-8071
Mailing Address - Fax:
Practice Address - Street 1:407 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1739
Practice Address - Country:US
Practice Address - Phone:732-416-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8612200Medicaid
NJ8612200Medicaid
038189Medicare ID - Type Unspecified