Provider Demographics
NPI:1134323595
Name:PATEL, ARVIND MANSUKH (MD)
Entity type:Individual
Prefix:MR
First Name:ARVIND
Middle Name:MANSUKH
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 PERRINE RD #203
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2836
Mailing Address - Country:US
Mailing Address - Phone:732-721-2200
Mailing Address - Fax:732-253-5550
Practice Address - Street 1:200 PERRINE RD #203
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2836
Practice Address - Country:US
Practice Address - Phone:732-721-2200
Practice Address - Fax:732-253-5550
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA031780208800000X
NJ031780208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0743003Medicaid
NJ1D0743003Medicaid
NJ0743003Medicaid