Healthcare Provider Details

I. General information

NPI: 1710464110
Provider Name (Legal Business Name): JINAL PATEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 10/26/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 DELSEA DR S
GLASSBORO NJ
08028-2621
US

IV. Provider business mailing address

128 CREAST HAVEN RD
CAPE MAY COURT HOUSE NJ
08210
US

V. Phone/Fax

Practice location:
  • Phone: 844-422-3632
  • Fax:
Mailing address:
  • Phone: 609-465-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00842500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00842500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: