Provider Demographics
NPI:1700971215
Name:PATTANAYAK, MINATI (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:MINATI
Middle Name:
Last Name:PATTANAYAK
Suffix:
Gender:F
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SOMERSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046
Mailing Address - Country:US
Mailing Address - Phone:609-877-4545
Mailing Address - Fax:609-877-5129
Practice Address - Street 1:89 SOMERSET DRIVE
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046
Practice Address - Country:US
Practice Address - Phone:609-877-4545
Practice Address - Fax:609-877-5129
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3358909Medicaid
NJB38837Medicare UPIN
NJ520372Medicare ID - Type Unspecified