Provider Demographics
NPI:1255354726
Name:PATEL, SUNIL (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
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:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-0178
Mailing Address - Country:US
Mailing Address - Phone:973-275-9500
Mailing Address - Fax:973-275-9501
Practice Address - Street 1:2010 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3437
Practice Address - Country:US
Practice Address - Phone:973-275-9500
Practice Address - Fax:973-275-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073729207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0010332Medicaid
NJ070125Medicare ID - Type Unspecified
NJ0010332Medicaid