Healthcare Provider Details

I. General information

NPI: 1992338701
Provider Name (Legal Business Name): GARDEN STATE MEDICAL PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 11/27/2023
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CHAMBERS ST
PRINCETON NJ
08542-3708
US

IV. Provider business mailing address

120 5TH AVE FL 5
NEW YORK NY
10011-5638
US

V. Phone/Fax

Practice location:
  • Phone: 855-563-2639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHILPA PATEL
Title or Position: CHIEF BUSINESS & LEGAL OFFICER
Credential:
Phone: 917-816-5370