Healthcare Provider Details

I. General information

NPI: 1881965184
Provider Name (Legal Business Name): GAURANG PATEL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 06/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAINT GEORGES AVE SUITE G
AVENEL NJ
07001
US

IV. Provider business mailing address

1500 SAINT GEORGES AVE SUITE G
AVENEL NJ
07001
US

V. Phone/Fax

Practice location:
  • Phone: 732-382-8111
  • Fax: 732-381-0292
Mailing address:
  • Phone: 732-382-8111
  • Fax: 732-381-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number250MA7434900
License Number StateNJ

VIII. Authorized Official

Name: GAURANG RAMANBHAI PATEL
Title or Position: OWNER OF GAURANG PATEL MD LLC
Credential: M.D.
Phone: 732-382-8111