Provider Demographics
NPI:1104938802
Name:PATEL, AMBARISH ASHOKKUMAR (DO)
Entity type:Individual
Prefix:DR
First Name:AMBARISH
Middle Name:ASHOKKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:707 WHITE HORSE RD
Mailing Address - Street 2:SUITE C-105
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2461
Mailing Address - Country:US
Mailing Address - Phone:856-258-4966
Mailing Address - Fax:856-258-4972
Practice Address - Street 1:707 WHITE HORSE RD
Practice Address - Street 2:SUITE C-105
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2461
Practice Address - Country:US
Practice Address - Phone:856-258-4966
Practice Address - Fax:856-258-4972
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB071495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8782008Medicaid
NJ8782008Medicaid
H58270Medicare UPIN