MEDICARE: MONA PATEL M D LLC

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	2084P0015X	Psychosomatic Medicine Physician	MA54437	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346456423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONA PATEL M D LLC

Provider Business Mailing Address
First Line	:	70 KINDERKAMACK RD
Second Line	:	SUITE 201
City	:	EMERSON
State	:	NJ
Zip	:	07630-1883
Country	:	US
Telephone Number	:	201-599-9700
Fax Number	:	201-599-3330

Provider Business Practice Location Address
First Line	:	70 KINDERKAMACK RD
Second Line	:	SUITE 201
City	:	EMERSON
State	:	NJ
Zip	:	07630-1883
Country	:	US
Telephone Number	:	201-599-9700
Fax Number	:	201-599-3330

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	MONA PATEL
Credential	:	M.D.
Telephone Number	:	201-599-9700

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	09/10/2007

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Directions to “MONA PATEL M D LLC ” Practice Location

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