Healthcare Provider Details

I. General information

NPI: 1689654089
Provider Name (Legal Business Name): JAY SANJAY PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 08/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MONTGOMERY DR
ANDERSON SC
29621-3334
US

IV. Provider business mailing address

2320 E NORTH ST STE K
GREENVILLE SC
29607-1250
US

V. Phone/Fax

Practice location:
  • Phone: 864-225-5597
  • Fax: 864-225-5835
Mailing address:
  • Phone: 850-339-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number29492
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number29492
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: