Provider Demographics
NPI:1194084756
Name:PATEL, RAVISH MUKESH (MD)
Entity type:Individual
Prefix:
First Name:RAVISH
Middle Name:MUKESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:312 APPLEGARTH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5347
Mailing Address - Country:US
Mailing Address - Phone:609-655-2700
Mailing Address - Fax:609-655-2565
Practice Address - Street 1:312 APPLEGARTH RD STE 207
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5347
Practice Address - Country:US
Practice Address - Phone:609-655-2700
Practice Address - Fax:609-655-2565
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09728000207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0472409Medicaid
NJ0472409Medicaid