=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033026976
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEEP PATEL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2026
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 S MAIN ST
-----------------------------------------------------
City | MULLICA HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08062-9402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-230-2919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 WOOD ACRES DR
-----------------------------------------------------
City | NORTH BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08902-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-404-1237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 263-035
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------