Healthcare Provider Details

I. General information

NPI: 1952265654
Provider Name (Legal Business Name): MEGHA GHANSHYAM PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 LAKE AVE
COLONIA NJ
07067-1131
US

IV. Provider business mailing address

2205 APPLEBY DR
OCEAN NJ
07712-4635
US

V. Phone/Fax

Practice location:
  • Phone: 732-396-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00978900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: