Provider Demographics
NPI:1952347619
Name:PARIKH, SANDIP K (MD)
Entity Type:Individual
Prefix:
First Name:SANDIP
Middle Name:K
Last Name:PARIKH
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 1:35 BEAVERSON BLVD
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7812
Mailing Address - Country:US
Mailing Address - Phone:732-262-0222
Mailing Address - Fax:732-262-0555
Practice Address - Street 1:35 BEAVERSON BLVD
Practice Address - Street 2:SUITE 6B
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7812
Practice Address - Country:US
Practice Address - Phone:732-262-0222
Practice Address - Fax:732-262-0555
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07089200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8556105Medicaid
NJ8556105Medicaid
NJ049227TN1Medicare ID - Type Unspecified