Healthcare Provider Details

I. General information

NPI: 1912867540
Provider Name (Legal Business Name): DEEP PATEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 PARK AVE
FLORHAM PARK NJ
07932-1003
US

IV. Provider business mailing address

175 PARK AVE
FLORHAM PARK NJ
07932-1003
US

V. Phone/Fax

Practice location:
  • Phone: 973-443-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: