=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548354327
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYMINKUMAR R. PATEL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 12/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5301 BROADWAY NHCAC
-----------------------------------------------------
City | WEST NEW YORK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07093-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-866-9320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5301 BROADWAY NORTH HUDSON COMMUNITY ACTION CORP.
-----------------------------------------------------
City | WEST NEW YORK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07093-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-866-9320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 25MA05559600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------