Provider Demographics
NPI:1487720918
Name:PRABHAKER S PATEL MD PA
Entity type:Organization
Organization Name:PRABHAKER S PATEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRABHAKER
Authorized Official - Middle Name:SOMABHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-228-0383
Mailing Address - Street 1:901 RT 168
Mailing Address - Street 2:STE 101
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-228-7577
Mailing Address - Fax:856-228-0534
Practice Address - Street 1:901 RT 168
Practice Address - Street 2:STE 101
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-228-7577
Practice Address - Fax:856-228-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8644802Medicaid
040231Medicare ID - Type Unspecified