Provider Demographics
NPI:1053559427
Name:PATEL, PALAKKUMAR KANTILAL (MD)
Entity type:Individual
Prefix:DR
First Name:PALAKKUMAR
Middle Name:KANTILAL
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 1:662 COMMONS WAY BLDG I4
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6431
Mailing Address - Country:US
Mailing Address - Phone:732-279-3681
Mailing Address - Fax:732-279-6043
Practice Address - Street 1:662 COMMONS WAY BLDG I4
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6431
Practice Address - Country:US
Practice Address - Phone:732-279-3681
Practice Address - Fax:732-279-6043
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437785207R00000X
NJ25MA09556300208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03133479Medicaid
NJ0448664Medicaid
PA102341647Medicaid
NJ0448664Medicaid
NY03133479Medicaid