Basic Information
| Provider Information | |||||||||
| NPI: | 1619053741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | ANIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34546 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086539399 | ||||||||
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| Practice Location | |||||||||
| Address1: | 466 OLD HOOK RD | ||||||||
| Address2: | SUITE 19 | ||||||||
| City: | EMERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076301396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019672455 | ||||||||
| FaxNumber: | 2016349647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
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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 | 207L00000X | 206588 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00045164 | 01 | RAIL ROAD MEDICARE | OTHER |