=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992828420
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NILESH MANOJ PATEL O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6000 BERGENLINE AVE
-----------------------------------------------------
City | WEST NEW YORK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07093-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-854-3411
-----------------------------------------------------
Fax | 201-854-9088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6000 BERGENLINE AVE
-----------------------------------------------------
City | WEST NEW YORK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07093-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-854-3411
-----------------------------------------------------
Fax | 201-854-9088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 27OA00535100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------