Provider Demographics
NPI:1588868749
Name:PATEL, RUSHITA H (MD)
Entity type:Individual
Prefix:DR
First Name:RUSHITA
Middle Name:H
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 FIR CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1873
Mailing Address - Country:US
Mailing Address - Phone:201-774-1007
Mailing Address - Fax:718-236-6391
Practice Address - Street 1:1835 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5706
Practice Address - Country:US
Practice Address - Phone:718-236-6025
Practice Address - Fax:718-236-6391
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08048500207Q00000X
NY242719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0182770Medicaid
NJ149296ZDAQOtherMEDICARE GROUP MEMBER PTAN
NY03053490Medicaid
NYA400005048OtherMEDICARE GROUP MEMBER PTAN