Provider Demographics
NPI:1063535664
Name:PATEL, PULIN H (MD)
Entity type:Individual
Prefix:DR
First Name:PULIN
Middle Name:H
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 1:22 MERIDIAN RD
Mailing Address - Street 2:UNIT 10
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2848
Mailing Address - Country:US
Mailing Address - Phone:732-243-9808
Mailing Address - Fax:732-791-5765
Practice Address - Street 1:22 MERIDIAN RD UNIT 10
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2848
Practice Address - Country:US
Practice Address - Phone:732-243-9808
Practice Address - Fax:732-791-5765
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 183518171000000X
NJ25MA08345000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121291NENMedicare PIN