Provider Demographics
NPI:1194082800
Name:PATEL, NITIN SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:NITIN
Middle Name:SURESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:19 DAVIS AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4488
Mailing Address - Country:US
Mailing Address - Phone:732-897-3990
Mailing Address - Fax:732-897-3997
Practice Address - Street 1:19 DAVIS AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-897-3990
Practice Address - Fax:732-897-3997
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10286800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995513Medicaid
NY53099AMedicare PIN
NY02995513Medicaid