=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104338045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATEL MEDICAL ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2017
-----------------------------------------------------
Last Update Date | 11/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2103 KLOCKNER RD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-586-4739
-----------------------------------------------------
Fax | 609-588-5314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2103 KLOCKNER RD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-586-4739
-----------------------------------------------------
Fax | 609-588-5314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN / OWNER
-----------------------------------------------------
Name | CHANDRESH A PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 609-586-4739
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------