Provider Demographics
NPI:1982692927
Name:PATEL, KAMAL (MD)
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:PATEL
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 1:1081 PARSIPPANY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1291
Mailing Address - Country:US
Mailing Address - Phone:973-917-3555
Mailing Address - Fax:973-917-3553
Practice Address - Street 1:1081 PARSIPPANY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1291
Practice Address - Country:US
Practice Address - Phone:973-917-3555
Practice Address - Fax:973-917-3553
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06726100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8732701Medicaid
G81153Medicare UPIN
NJ8732701Medicaid