Healthcare Provider Details

I. General information

NPI: 1407816721
Provider Name (Legal Business Name): PANKAJ HARJI PATEL MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

IV. Provider business mailing address

1100 WALNUT ST SUITE 500
PHILADELPHIA PA
19107-5563
US

V. Phone/Fax

Practice location:
  • Phone: 609-441-8023
  • Fax:
Mailing address:
  • Phone: 215-955-6760
  • Fax: 215-923-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-059559-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD-059559-L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number25MA06896800
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number25MA06896800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: