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General NPI Number Information
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NPI Number | 1417580762
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Entity Type | Individual
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Provider Name | HARSH AJAY PATEL
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Gender | Male
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 321 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-2120
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Country | US
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Telephone | 862-203-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 362 COPELAND AVE
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City | LYNDHURST
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State | NJ
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Zip | 07071-3120
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Country | US
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Telephone | 862-596-3803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02296000
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License Number State | NJ
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