MEDICARE: DR. PURUSHOTTAM CHUNILAL 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	207R00000X	Internal Medicine Physician	MA028237	NJ

General Provider Information

NPI Number	:	1881818086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PURUSHOTTAM CHUNILAL PATEL MD

Provider Business Mailing Address
First Line	:	8 FROST AVE W
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3165
Country	:	US
Telephone Number	:	732-321-1599
Fax Number	:	732-321-5343

Provider Business Practice Location Address
First Line	:	8 FROST AVE W
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3165
Country	:	US
Telephone Number	:	732-321-1599
Fax Number	:	732-321-5343

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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