Provider Demographics
NPI:1831263334
Name:PATEL, SUGNAYKUMAR PURUSHOTTAM (MD)
Entity type:Individual
Prefix:DR
First Name:SUGNAYKUMAR
Middle Name:PURUSHOTTAM
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SUGNAY
Other - Middle Name:PURUSHOTTAM
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4785 N 1ST ST FL 4
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0513
Practice Address - Country:US
Practice Address - Phone:559-448-4323
Practice Address - Fax:559-448-4950
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA073749002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056720C2BOtherMEDICARE BILLING NO.
PAG79183Medicare UPIN