Provider Demographics
NPI:1649320359
Name:PATEL, MAYUR VINOD (MD)
Entity type:Individual
Prefix:
First Name:MAYUR
Middle Name:VINOD
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 1:565 HIGHWAY 35
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5047
Mailing Address - Country:US
Mailing Address - Phone:732-530-1058
Mailing Address - Fax:732-530-1419
Practice Address - Street 1:565 HIGHWAY 35
Practice Address - Street 2:SUITE 7
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5047
Practice Address - Country:US
Practice Address - Phone:732-530-1058
Practice Address - Fax:732-530-1419
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07534600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064246Medicaid
NJ090833ZF4XMedicare PIN
NJ090833Medicare PIN
NJ090833ZF4XMedicare PIN