Provider Demographics
NPI:1871718775
Name:PATEL, JAYENDRA M (MD)
Entity type:Individual
Prefix:
First Name:JAYENDRA
Middle Name:M
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:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0748
Mailing Address - Country:US
Mailing Address - Phone:800-345-0064
Mailing Address - Fax:973-740-1350
Practice Address - Street 1:727 N BEERS ST
Practice Address - Street 2:BAYSHORE COMMUNITY HOSPITAL
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1514
Practice Address - Country:US
Practice Address - Phone:732-739-5968
Practice Address - Fax:973-740-1350
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61072207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056693Medicaid
NJ085231Medicare PIN
NJ0056693Medicaid