Basic Information
| Provider Information | |||||||||
| NPI: | 1013983998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | MANISH | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 PATERSON ST | ||||||||
| Address2: | ROOM 2330 | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322356539 | ||||||||
| FaxNumber: | 7322357144 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 PATERSON ST | ||||||||
| Address2: | ROOM 2330 | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322356539 | ||||||||
| FaxNumber: | 7322357144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 09/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA08332100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036116200 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00758839 | 01 | NJ | R R MCR | OTHER | PAR | 01 | VA | CORVEL COR CARE | OTHER | 188794 | 01 | VA | ATHEM BC/BS VA/HK | OTHER | PAR | 01 | VA | MULTI PLAN | OTHER | PAR | 01 | VA | MID-ATLANTIC VICARE | OTHER | 5902100 | 05 | NC | MEDICAID | -028 | 01 | VA | CHAMPUS/TRICARE | OTHER | 010202906 | 05 | VA | MEDICAID | 0169820 | 05 | NJ | MEDICAID | 5902100 | 01 | NC | BC/BS NC | OTHER |