MEDICARE: DR. NISHANT PATEL PSY.D.

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	103TC0700X	Clinical Psychologist	PS017147	PA

General Provider Information

NPI Number	:	1164797247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHANT PATEL PSY.D.

Provider Business Mailing Address
First Line	:	40 CRESTWOOD DR
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08690-1938
Country	:	US
Telephone Number	:	609-947-6857
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 JOURNAL SQUARE PLZ
Second Line	:	4TH FLOOR
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-4004
Country	:	US
Telephone Number	:	609-947-6857
Fax Number	:

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

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	03/21/2012

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