Basic Information
Provider Information
NPI: 1396022125
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: HASITKUMAR
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1925 PACIFIC AVE
Address2:  
City: ATLANTIC CITY
State: NJ
PostalCode: 084016713
CountryCode: US
TelephoneNumber: 6094418146
FaxNumber: 6094418002
Practice Location
Address1: 1925 PACIFIC AVE
Address2:  
City: ATLANTIC CITY
State: NJ
PostalCode: 084016713
CountryCode: US
TelephoneNumber: 6094418146
FaxNumber: 6094418002
Other Information
ProviderEnumerationDate: 11/08/2011
LastUpdateDate: 04/09/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X25MA09290400NJY Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X25MA09290400NJN Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


Home