Provider Demographics
NPI:1932874948
Name:PATEL, SANAM (MDCM)
Entity Type:Individual
Prefix:
First Name:SANAM
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MDCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RALEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1700
Mailing Address - Country:US
Mailing Address - Phone:732-735-1021
Mailing Address - Fax:
Practice Address - Street 1:4 RALEIGH WAY
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1700
Practice Address - Country:US
Practice Address - Phone:848-228-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine