Healthcare Provider Details

I. General information

NPI: 1801163738
Provider Name (Legal Business Name): LOPA M PATEL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 WALNUT ST
MONTCLAIR NJ
07042-3802
US

IV. Provider business mailing address

160 WALNUT ST
MONTCLAIR NJ
07042-3802
US

V. Phone/Fax

Practice location:
  • Phone: 973-577-4477
  • Fax:
Mailing address:
  • Phone: 973-783-5276
  • Fax: 973-783-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA07974200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA07974200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA07974200
License Number StateNJ

VIII. Authorized Official

Name: LOPA PATEL
Title or Position: MD
Credential:
Phone: 973-783-5276