Healthcare Provider Details

I. General information

NPI: 1528139961
Provider Name (Legal Business Name): DINESH G PATEL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117-119 ROOSEVELT AVENUE
PLAINFIELD NJ
07060-1331
US

IV. Provider business mailing address

117-119 ROOSEVELT AVENUE
PLAINFIELD NJ
07060-1331
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-6870
  • Fax: 908-756-5566
Mailing address:
  • Phone: 908-756-6870
  • Fax: 908-756-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA05775300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5616603
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: