Healthcare Provider Details

I. General information

NPI: 1609806843
Provider Name (Legal Business Name): DIXIT DINESH PATEL D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 BROADWAY
ELMWOOD PARK NJ
07407-1836
US

IV. Provider business mailing address

2005 TIMBER OAKS RD
EDISON NJ
08820-4405
US

V. Phone/Fax

Practice location:
  • Phone: 201-794-3223
  • Fax:
Mailing address:
  • Phone: 732-322-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00288200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: