Provider Demographics
NPI:1801979901
Name:PATEL, JATINCHANDRA (DO)
Entity type:Individual
Prefix:
First Name:JATINCHANDRA
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 TENNENT RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8288
Mailing Address - Country:US
Mailing Address - Phone:732-851-4700
Mailing Address - Fax:732-851-4703
Practice Address - Street 1:831 TENNENT RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8288
Practice Address - Country:US
Practice Address - Phone:732-851-4700
Practice Address - Fax:732-851-4703
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07485500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB07485500OtherLICENSE #