Healthcare Provider Details

I. General information

NPI: 1588790281
Provider Name (Legal Business Name): KIRTIKUMAR J PATEL M.D. F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NEW BRUNSWICK AVE
PERTH AMBOY NJ
08861-3654
US

IV. Provider business mailing address

454 KOSCIUSKO AVE
SOUTH PLAINFIELD NJ
07080-3961
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-3700
  • Fax:
Mailing address:
  • Phone: 908-222-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA08020500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.202858
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: