Provider Demographics
NPI:1447299623
Name:PATEL, SUBODH H (MD)
Entity type:Individual
Prefix:DR
First Name:SUBODH
Middle Name:H
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 1:1031 MCBRIDE AVE
Mailing Address - Street 2:SUITE D212
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2559
Mailing Address - Country:US
Mailing Address - Phone:973-890-1303
Mailing Address - Fax:973-890-5609
Practice Address - Street 1:1031 MCBRIDE AVE
Practice Address - Street 2:SUITE D212
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2559
Practice Address - Country:US
Practice Address - Phone:973-890-1303
Practice Address - Fax:973-890-5609
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA031252207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPS159OtherOXFORD
NJ1753207Medicaid
NJ1K8732OtherHEALTHNET
NJ4452559OtherAETNA PPO
NJ0104821000OtherAMERIHEALTH
NJ5V9771OtherEMPIRE BC/BS
NJ2569865OtherAETNA HMO
NJ0013836OtherGHI PPO
NJ100016032OtherRAILROAD MEDICARE
NJ2569865OtherAETNA HMO
NJ5V9771OtherEMPIRE BC/BS