Provider Demographics
NPI:1689654089
Name:PATEL, JAY SANJAY (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:SANJAY
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 1:2320 E NORTH ST STE K
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1250
Mailing Address - Country:US
Mailing Address - Phone:850-339-1359
Mailing Address - Fax:
Practice Address - Street 1:108 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3334
Practice Address - Country:US
Practice Address - Phone:864-225-5597
Practice Address - Fax:864-225-5835
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC294922081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6089OtherMEDICARE GROUP
SCAA22586089OtherMEDICARE PTAN
SC294924Medicaid
SC294924Medicaid