Healthcare Provider Details

I. General information

NPI: 1235166489
Provider Name (Legal Business Name): KRISHNA PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PITTSTOWN ROAD HUNTERDON DEVELOPMENTAL CENTER
CLINTON NJ
08809-4008
US

IV. Provider business mailing address

40 PITTSTOWN ROAD STATE OF NEW JERSEY /HUNTERDON DEVELOPMENTAL CENTER
CLINTON NJ
08809-0000
US

V. Phone/Fax

Practice location:
  • Phone: 908-735-4031
  • Fax: 908-730-1340
Mailing address:
  • Phone: 908-735-4031
  • Fax: 908-730-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA04200300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: