Healthcare Provider Details

I. General information

NPI: 1619053741
Provider Name (Legal Business Name): ANIL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 OLD HOOK RD SUITE 19
EMERSON NJ
07630-1396
US

IV. Provider business mailing address

PO BOX 34546
NEWARK NJ
07189-0001
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-2455
  • Fax: 201-634-9647
Mailing address:
  • Phone: 908-653-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number206588
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: