Provider Demographics
NPI:1215108188
Name:PATEL, PRIYESH (MD)
Entity type:Individual
Prefix:DR
First Name:PRIYESH
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 1:1295 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2702
Mailing Address - Country:US
Mailing Address - Phone:609-914-7017
Mailing Address - Fax:609-261-4180
Practice Address - Street 1:210 ARK RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3188
Practice Address - Country:US
Practice Address - Phone:609-261-4500
Practice Address - Fax:609-261-4180
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA090644002085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0362344Medicaid
NJ292750Medicare PIN