Healthcare Provider Details

I. General information

NPI: 1093378457
Provider Name (Legal Business Name): JENA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 3600S
HAWTHORNE NY
10532-2186
US

IV. Provider business mailing address

2251 MANN RD
LANSDALE PA
19446-5860
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-7636
  • Fax:
Mailing address:
  • Phone: 484-803-8532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number346880
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: