Healthcare Provider Details

I. General information

NPI: 1679488951
Provider Name (Legal Business Name): DHRUTI PATEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 LAKEWOOD RD STE 1
TOMS RIVER NJ
08755-1929
US

IV. Provider business mailing address

2980 COLUMBIA DR
BENSALEM PA
19020-2108
US

V. Phone/Fax

Practice location:
  • Phone: 732-719-7788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP01044400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: