Healthcare Provider Details

I. General information

NPI: 1417427261
Provider Name (Legal Business Name): KRISHNA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 PIERMONT RD STE B
ROCKLEIGH NJ
07647-2702
US

IV. Provider business mailing address

19 DODGE ST
BAYONNE NJ
07002-4304
US

V. Phone/Fax

Practice location:
  • Phone: 201-750-8310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00724100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: