=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477274421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMAR S PATEL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2022
-----------------------------------------------------
Last Update Date | 09/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49 VERONICA AVE STE 106
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-6802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-795-5464
-----------------------------------------------------
Fax | 908-975-5466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 LATOURELLE DR
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08844-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-989-2996
-----------------------------------------------------
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 | 28RI03608900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------