=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932912508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RIA PATEL PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 KNICKERBOCKER RD STE 1500
-----------------------------------------------------
City | CRESSKILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07626-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-374-1718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 MARSHA TER
-----------------------------------------------------
City | PARSIPPANY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07054-4114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-216-9401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1209176
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------