Healthcare Provider Details

I. General information

NPI: 1861988388
Provider Name (Legal Business Name): CHARMI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE STE 103
AVENEL NJ
07001-1390
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE STE 103
AVENEL NJ
07001-1390
US

V. Phone/Fax

Practice location:
  • Phone: 732-734-1310
  • Fax: 948-202-6572
Mailing address:
  • Phone: 732-734-1310
  • Fax: 948-202-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA11081200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: