Healthcare Provider Details

I. General information

NPI: 1124394002
Provider Name (Legal Business Name): KOMAL PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

IV. Provider business mailing address

153 SPLIT ROCK RD
PARAMUS NJ
07652-4400
US

V. Phone/Fax

Practice location:
  • Phone: 201-982-2604
  • Fax: 201-215-9776
Mailing address:
  • Phone: 201-982-2604
  • Fax: 201-215-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number374984
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10026300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number285609
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number285609-1
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA10026300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: