Healthcare Provider Details

I. General information

NPI: 1033026976
Provider Name (Legal Business Name): DEEP PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 S MAIN ST
MULLICA HILL NJ
08062-9402
US

IV. Provider business mailing address

10 WOOD ACRES DR
NORTH BRUNSWICK NJ
08902-2526
US

V. Phone/Fax

Practice location:
  • Phone: 856-230-2919
  • Fax:
Mailing address:
  • Phone: 551-404-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number263-035
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: