Provider Demographics
NPI:1841460144
Name:PATEL, AMISH THAKOR (DO)
Entity type:Individual
Prefix:DR
First Name:AMISH
Middle Name:THAKOR
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1101 RARITAN RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1315
Mailing Address - Country:US
Mailing Address - Phone:732-381-3055
Mailing Address - Fax:732-815-9330
Practice Address - Street 1:1101 RARITAN RD
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1315
Practice Address - Country:US
Practice Address - Phone:732-381-3055
Practice Address - Fax:732-815-9330
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08759900207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0249246Medicaid
NJ800601Medicare PIN