Provider Demographics
NPI:1982614400
Name:PATEL, PANKAJ V (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PANKAJKUMAR
Other - Middle Name:V
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1920 OAK TREE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2132
Mailing Address - Country:US
Mailing Address - Phone:732-516-1244
Mailing Address - Fax:732-516-1255
Practice Address - Street 1:1920 OAK TREE RD STE 201
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2132
Practice Address - Country:US
Practice Address - Phone:732-516-1244
Practice Address - Fax:732-516-1255
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8563802Medicaid
NJ8563802Medicaid
G87050Medicare UPIN