Healthcare Provider Details

I. General information

NPI: 1275267478
Provider Name (Legal Business Name): POOJA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ANGELA CT
PISCATAWAY NJ
08854-5753
US

IV. Provider business mailing address

2 ANGELA CT
PISCATAWAY NJ
08854-5753
US

V. Phone/Fax

Practice location:
  • Phone: 732-710-0672
  • Fax:
Mailing address:
  • Phone: 732-710-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00714500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003958
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: