Provider Demographics
NPI:1194800243
Name:PATEL, KUMAR (MD)
Entity type:Individual
Prefix:
First Name:KUMAR
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 1:245 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1942
Mailing Address - Country:US
Mailing Address - Phone:201-327-0220
Mailing Address - Fax:
Practice Address - Street 1:1050 WALL ST W
Practice Address - Street 2:SUITE 360
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3621
Practice Address - Country:US
Practice Address - Phone:201-821-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA575112086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5350409Medicaid
NJ5350409Medicaid
NJ415703Medicare ID - Type Unspecified