Healthcare Provider Details

I. General information

NPI: 1356742167
Provider Name (Legal Business Name): JESSICA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-7913
US

IV. Provider business mailing address

343 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-7913
US

V. Phone/Fax

Practice location:
  • Phone: 908-418-7446
  • Fax:
Mailing address:
  • Phone: 908-418-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03655600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: