Healthcare Provider Details

I. General information

NPI: 1134664717
Provider Name (Legal Business Name): PURVESH D PATEL APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/24/2021
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COOPER RD STE 16
VOORHEES NJ
08043-8007
US

IV. Provider business mailing address

101 COLUMBIA BLVD
CHERRY HILL NJ
08002-1111
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-2224
  • Fax: 856-429-1926
Mailing address:
  • Phone: 856-426-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18553800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01066000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: