Provider Demographics
NPI:1881965184
Name:GAURANG PATEL MD LLC
Entity type:Organization
Organization Name:GAURANG PATEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF GAURANG PATEL MD LLC
Authorized Official - Prefix:
Authorized Official - First Name:GAURANG
Authorized Official - Middle Name:RAMANBHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-382-8111
Mailing Address - Street 1:1500 SAINT GEORGES AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001
Mailing Address - Country:US
Mailing Address - Phone:732-382-8111
Mailing Address - Fax:732-381-0292
Practice Address - Street 1:1500 SAINT GEORGES AVE
Practice Address - Street 2:SUITE G
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001
Practice Address - Country:US
Practice Address - Phone:732-382-8111
Practice Address - Fax:732-381-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ250MA7434900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0080071Medicaid