Healthcare Provider Details

I. General information

NPI: 1750077707
Provider Name (Legal Business Name): GORAL PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES ST
EDISON NJ
08820-3947
US

IV. Provider business mailing address

65 JAMES ST
EDISON NJ
08820-3947
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03048900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: