Provider Demographics
NPI:1053335083
Name:PATEL, SANJAY (DPM)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 BROAD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3273
Mailing Address - Country:US
Mailing Address - Phone:203-876-7736
Mailing Address - Fax:
Practice Address - Street 1:247 BROAD ST STE 3
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3273
Practice Address - Country:US
Practice Address - Phone:203-876-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000509213E00000X, 335E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No335E00000XSuppliersProsthetic/Orthotic Supplier
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004099257Medicaid
CT030000509CT05OtherBLUE CROSS BLUE SHIELD
CT000509J185OtherCIGNA HEALTHCARE
CTNHS138OtherOXFORD HEALTH PLAN
CT2885050004OtherCIGNA HEALTHCARE
CT030000509CT06OtherBLUE CROSS BLUE SHIELD
CT480035180OtherRAILROAD MEDICARE
CTNHS138OtherOXFORD HEALTH PLAN
CT4714640001Medicare NSC
CT480000907Medicare PIN