Provider Demographics
NPI:1255429361
Name:PATANKAR, SANJIV KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:SANJIV
Middle Name:KRISHNA
Last Name:PATANKAR
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 1:620 CRANBURY ROAD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4098
Mailing Address - Country:US
Mailing Address - Phone:732-238-2662
Mailing Address - Fax:732-613-5359
Practice Address - Street 1:620 CRANBURY ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4098
Practice Address - Country:US
Practice Address - Phone:732-238-2662
Practice Address - Fax:732-613-5359
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07397500208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8890307Medicaid
057934QLYMedicare ID - Type Unspecified
NJ8890307Medicaid