Healthcare Provider Details

I. General information

NPI: 1760740617
Provider Name (Legal Business Name): CHANDNI PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2012
Last Update Date: 09/30/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE MOB2 PEDIATRIC CARDIOLOGY
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

254 EASTON AVE MOB2 PEDIATRIC CARDIOLOGY
NEW BRUNSWICK NJ
08901
US

V. Phone/Fax

Practice location:
  • Phone: 732-846-2855
  • Fax: 732-745-4680
Mailing address:
  • Phone: 732-846-2855
  • Fax: 732-745-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MA10647100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: