Healthcare Provider Details

I. General information

NPI: 1417396771
Provider Name (Legal Business Name): PRACHI H. PATEL D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MANTUA PIKE STE 8
WOODBURY HEIGHTS NJ
08097-1141
US

IV. Provider business mailing address

722 MANTUA PIKE STE 8
WOODBURY HEIGHTS NJ
08097-1141
US

V. Phone/Fax

Practice location:
  • Phone: 856-384-1333
  • Fax: 856-384-1297
Mailing address:
  • Phone: 856-384-1333
  • Fax: 856-384-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number274346-211
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00330400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: