Healthcare Provider Details

I. General information

NPI: 1710509302
Provider Name (Legal Business Name): HARSH PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 JACK MARTIN BLVD
BRICK NJ
08724-7732
US

IV. Provider business mailing address

425 JACK MARTIN BLVD
BRICK NJ
08724-7732
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-2200
  • Fax:
Mailing address:
  • Phone: 732-840-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12138600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD495149
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: