Healthcare Provider Details

I. General information

NPI: 1447288378
Provider Name (Legal Business Name): DEEPAK VALJIBHAI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CREEKSIDE CT
SECAUCUS NJ
07094-3750
US

IV. Provider business mailing address

34 CREEKSIDE CT
SECAUCUS NJ
07094-3750
US

V. Phone/Fax

Practice location:
  • Phone: 201-463-3439
  • Fax:
Mailing address:
  • Phone: 201-463-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07527300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MA07527300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA07527300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: