MEDICARE: DR. SUBODH H PATEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MA031252	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	100016032	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS159	OTHER	NJ	OXFORD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1K8732	OTHER	NJ	HEALTHNET
4	4452559	OTHER	NJ	AETNA PPO
5	0104821000	OTHER	NJ	AMERIHEALTH
6	5V9771	OTHER	NJ	EMPIRE BC/BS
7	2569865	OTHER	NJ	AETNA HMO
8	0013836	OTHER	NJ	GHI PPO

General Provider Information

NPI Number	:	1447299623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUBODH H PATEL MD

Provider Business Mailing Address
First Line	:	1031 MCBRIDE AVE
Second Line	:	SUITE D212
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-2559
Country	:	US
Telephone Number	:	973-890-1303
Fax Number	:	973-890-5609

Provider Business Practice Location Address
First Line	:	1031 MCBRIDE AVE
Second Line	:	SUITE D212
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-2559
Country	:	US
Telephone Number	:	973-890-1303
Fax Number	:	973-890-5609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	04/22/2013

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