Provider Demographics
NPI:1750349965
Name:PATEL, MADANMOHAN R (MD,FCCP)
Entity type:Individual
Prefix:DR
First Name:MADANMOHAN
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4400
Mailing Address - Country:US
Mailing Address - Phone:201-634-1506
Mailing Address - Fax:201-215-9776
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-634-1506
Practice Address - Fax:201-215-9776
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069221207RP1001X, 207RS0012X
NY187712207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0002712Medicaid
NY01982627Medicaid
NY198AL1Medicare ID - Type Unspecified
F05766Medicare UPIN
NJ0002712Medicaid