Healthcare Provider Details

I. General information

NPI: 1427277821
Provider Name (Legal Business Name): AMEE SHIRISH PATRAWALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN STREET, ROOM I-354 UMDNJ-NJ MEDICAL SCHOOL PULMONARY CRITICAL CARE
NEWARK NJ
07103
US

IV. Provider business mailing address

150 BERGEN STREET, ROOM I-354 UMDNJ-NJ MEDICAL SCHOOL PULMONARY CRITICAL CARE
NEWARK NJ
07103
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-6111
  • Fax:
Mailing address:
  • Phone: 973-972-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA08432700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number231822
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA08432700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: