Healthcare Provider Details

I. General information

NPI: 1952720807
Provider Name (Legal Business Name): SHIL PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 707
HACKENSACK NJ
07601-1963
US

IV. Provider business mailing address

20 PROSPECT AVE STE 707
HACKENSACK NJ
07601-1963
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-3091
  • Fax:
Mailing address:
  • Phone: 551-996-3091
  • Fax: 551-996-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MB10442900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number86108
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB10442900
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86108
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: