Healthcare Provider Details

I. General information

NPI: 1023044104
Provider Name (Legal Business Name): JAYENDRA N. PATEL M.D., F.A.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 N MAIN ST
MARLBORO NJ
07746-1429
US

IV. Provider business mailing address

32 N MAIN ST
MARLBORO NJ
07746-1429
US

V. Phone/Fax

Practice location:
  • Phone: 732-462-4100
  • Fax: 732-462-3798
Mailing address:
  • Phone: 732-462-4100
  • Fax: 732-462-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA05982000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: