Provider Demographics
NPI:1548354327
Name:PATEL, JAYMINKUMAR R (MD)
Entity type:Individual
Prefix:
First Name:JAYMINKUMAR
Middle Name:R
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 1:5301 BROADWAY
Mailing Address - Street 2:NORTH HUDSON COMMUNITY ACTION CORP.
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2622
Mailing Address - Country:US
Mailing Address - Phone:201-866-9320
Mailing Address - Fax:
Practice Address - Street 1:5301 BROADWAY
Practice Address - Street 2:NHCAC
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2622
Practice Address - Country:US
Practice Address - Phone:201-866-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05559600207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4988400Medicaid