Healthcare Provider Details

I. General information

NPI: 1538353206
Provider Name (Legal Business Name): SHAMIK PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 ROCKWOOD RD
FLORHAM PARK NJ
07932-2616
US

IV. Provider business mailing address

109 ROCKWOOD RD
FLORHAM PARK NJ
07932-2616
US

V. Phone/Fax

Practice location:
  • Phone: 908-451-2856
  • Fax:
Mailing address:
  • Phone: 908-451-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MB08788400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08788400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: