Provider Demographics
NPI:1912979097
Name:PATEL, SHAIL N (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAIL
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 STELTON ROAD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3244
Mailing Address - Country:US
Mailing Address - Phone:732-968-9494
Mailing Address - Fax:732-968-4703
Practice Address - Street 1:234 STELTON ROAD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3244
Practice Address - Country:US
Practice Address - Phone:732-968-9494
Practice Address - Fax:732-968-4703
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00282600213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV05583Medicare UPIN
NJ092361BSDMedicare ID - Type Unspecified
NJ092361BDQMedicare PIN