=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184908634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DINESHKUMAR A PATEL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2011
-----------------------------------------------------
Last Update Date | 01/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 GREENWICH ST
-----------------------------------------------------
City | BELVIDERE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07823-1449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-475-1060
-----------------------------------------------------
Fax | 908-475-1130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 ROYAL DR APT 141
-----------------------------------------------------
City | PISCATAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08854-3190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-529-6493
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI03442200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------