Provider Demographics
NPI:1023125531
Name:PATEL, RAJESH I (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 BLACK HORSE PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2962
Mailing Address - Country:US
Mailing Address - Phone:609-652-8316
Mailing Address - Fax:609-653-8764
Practice Address - Street 1:1925 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:609-652-6270
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA072447002085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00758340OtherRAILROAD MEDICARE
NJP00847818OtherRAILROAD MEDICARE
NJ300122831OtherRAILROAD MEDICARE
NJ8507207Medicaid
NJ048745AMLMedicare PIN
NJP00847818OtherRAILROAD MEDICARE
NJ8507207Medicaid
NJ048745ZEKDMedicare PIN