Healthcare Provider Details

I. General information

NPI: 1851397574
Provider Name (Legal Business Name): PRATIK PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/20/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 APPLEGARTH RD STE G
MONROE NJ
08831-3822
US

IV. Provider business mailing address

11 MERIDIAN RD
EATONTOWN NJ
07724-2242
US

V. Phone/Fax

Practice location:
  • Phone: 732-210-3285
  • Fax: 732-242-6655
Mailing address:
  • Phone: 732-663-0300
  • Fax: 732-663-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA068459
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: