MEDICARE: MAMTA A PATEL APN FNP BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00930900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053968321	OTHER	NJ	CDS

General Provider Information

NPI Number	:	1053968321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMTA A PATEL APN FNP BC

Provider Business Mailing Address
First Line	:	680 DARMODY AVE
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08902-4547
Country	:	US
Telephone Number	:	732-429-2316
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 DARMODY AVE
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-0890
Country	:	US
Telephone Number	:	732-429-2316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	07/17/2024

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