Healthcare Provider Details

I. General information

NPI: 1225180516
Provider Name (Legal Business Name): RITESH PATEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

1007 CHARTER ST
PISCATAWAY NJ
08854-3305
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5422
  • Fax:
Mailing address:
  • Phone: 732-968-4829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00073800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: