Provider Demographics
NPI:1053418459
Name:PATEL, MANISH S (MD)
Entity type:Individual
Prefix:DR
First Name:MANISH
Middle Name:S
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 1:15 SCHOOLHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3518
Mailing Address - Country:US
Mailing Address - Phone:646-645-6592
Mailing Address - Fax:
Practice Address - Street 1:520 WESTFIELD AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1658
Practice Address - Country:US
Practice Address - Phone:908-994-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA074156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9125809Medicaid
NJH45498Medicare UPIN
NJ9125809Medicaid