Provider Demographics
NPI:1720113962
Name:PATEL, SANJIV C (MD)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 E 3RD ST
Mailing Address - Street 2:STE 2
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2924
Mailing Address - Country:US
Mailing Address - Phone:856-234-2500
Mailing Address - Fax:856-234-3907
Practice Address - Street 1:147 E 3RD ST
Practice Address - Street 2:STE 2
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2924
Practice Address - Country:US
Practice Address - Phone:856-234-2500
Practice Address - Fax:856-234-3907
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05916000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7559500Medicaid
NJF80270Medicare UPIN
NJ014490NSKMedicare ID - Type Unspecified