Healthcare Provider Details

I. General information

NPI: 1457464810
Provider Name (Legal Business Name): ARVIND PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MYRTLE AVE 58
PLAINFIELD NJ
07063-1000
US

IV. Provider business mailing address

30 HARDWICK DR
KENDALL PARK NJ
08824-7020
US

V. Phone/Fax

Practice location:
  • Phone: 908-753-6401
  • Fax: 908-753-6401
Mailing address:
  • Phone: 908-753-6401
  • Fax: 908-753-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number014374
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1175234
Identifier TypeMEDICAID
Identifier StateLA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: