=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801125885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KUNJESH A PATEL PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2009
-----------------------------------------------------
Last Update Date | 03/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 HARRISON AVE
-----------------------------------------------------
City | KEARNY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07032-5950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-955-0162
-----------------------------------------------------
Fax | 201-955-0345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2508 PLAZA DR
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07095-1134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-240-3456
-----------------------------------------------------
Fax | 201-955-0345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 053869
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PCT.0011480
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI03343400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP449307
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------