Provider Demographics
NPI:1639242852
Name:PATEL, PRABHAKER SOMABHAI (MD)
Entity type:Individual
Prefix:
First Name:PRABHAKER
Middle Name:SOMABHAI
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 1:901 ROUTE 168
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-228-7577
Mailing Address - Fax:856-228-0534
Practice Address - Street 1:901 ROUTE 168
Practice Address - Street 2:SUITE 101
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-228-7577
Practice Address - Fax:856-228-0534
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0470502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0382344000OtherAMERIHEALTH
NJ2497107Medicaid
C54262Medicare UPIN
NJ2497107Medicaid