MEDICARE: MINAL PATEL DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2084N0400X	Neurology Physician	25MB11850300	NJ

General Provider Information

NPI Number	:	1265927354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINAL PATEL DO

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-3533
Country	:	US
Telephone Number	:	973-895-6606
Fax Number	:	973-895-5378

Provider Business Practice Location Address
First Line	:	333 MOUNT HOPE AVE
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-1654
Country	:	US
Telephone Number	:	973-895-6606
Fax Number	:	973-895-5378

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

Provider Enumeration Date	:	06/30/2018
Last Update Date	:	10/05/2023

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