Provider Demographics
NPI:1841255981
Name:PATEL, C J (MD)
Entity type:Individual
Prefix:
First Name:C
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:MINOTOLA
Mailing Address - State:NJ
Mailing Address - Zip Code:08341-0698
Mailing Address - Country:US
Mailing Address - Phone:856-697-0111
Mailing Address - Fax:856-697-0685
Practice Address - Street 1:CENTRAL AND SUMMER AVENUES
Practice Address - Street 2:
Practice Address - City:MINOTOLA
Practice Address - State:NJ
Practice Address - Zip Code:08341
Practice Address - Country:US
Practice Address - Phone:856-697-0111
Practice Address - Fax:856-697-0685
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3634507Medicaid
NJ3634507Medicaid
NJ000668Medicare PIN