Healthcare Provider Details

I. General information

NPI: 1588659296
Provider Name (Legal Business Name): SAMIR G PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/11/2025
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 MAIN ST STE 1
SPOTSWOOD NJ
08884-1739
US

IV. Provider business mailing address

6 SANIBEL CT
MONROE TWP NJ
08831-5817
US

V. Phone/Fax

Practice location:
  • Phone: 732-416-0065
  • Fax:
Mailing address:
  • Phone: 732-416-0065
  • Fax: 732-416-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06726200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: