Healthcare Provider Details

I. General information

NPI: 1730900408
Provider Name (Legal Business Name): PRIYANKA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4247 US 9
FREEHOLD NJ
07728-8307
US

IV. Provider business mailing address

1220 MORNING GLORY DR
MONROE TOWNSHIP NJ
08831-5352
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-7650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15081900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: