Healthcare Provider Details

I. General information

NPI: 1053559427
Provider Name (Legal Business Name): PALAKKUMAR KANTILAL PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 COMMONS WAY BLDG I4
TOMS RIVER NJ
08755-6431
US

IV. Provider business mailing address

662 COMMONS WAY BLDG I4
TOMS RIVER NJ
08755-6431
US

V. Phone/Fax

Practice location:
  • Phone: 732-279-3681
  • Fax: 732-279-6043
Mailing address:
  • Phone: 732-279-3681
  • Fax: 732-279-6043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA09556300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09556300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD437785
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: