Healthcare Provider Details

I. General information

NPI: 1720982622
Provider Name (Legal Business Name): BHOOMI MANUBHAI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WOOD CHASE LN
KINNELON NJ
07405-3334
US

IV. Provider business mailing address

3 WOOD CHASE LN
KINNELON NJ
07405-3334
US

V. Phone/Fax

Practice location:
  • Phone: 980-777-4675
  • Fax:
Mailing address:
  • Phone: 980-777-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NR21531100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: