Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA03959800 | NJ |
NPI | 1053466672 |
---|---|
Provider Name | Amita N Patel |
First Address | Elizabeth, NJ 07202-2212 |
Second Address | Elizabeth, NJ 07202-2212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0433705 | (05) | NJ |
E13863 | (02) | NJ |