Healthcare Provider Details

I. General information

NPI: 1053767541
Provider Name (Legal Business Name): KRUPESH BHAGAVAT PATEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE FL 3
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

465 SOUTH ST STE 103
MORRISTOWN NJ
07960-6442
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-6720
  • Fax: 973-401-2410
Mailing address:
  • Phone: 732-771-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number25MB12807300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberOS19003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: