Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MB09947700 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MB09947700 | NJ |
NPI | 1093158628 |
---|---|
Provider Name | Dr. Kamal Bharat Patel |
First Address | Amenia, NY 12501-0069 |
Second Address | Bedford, MA 01730-1198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2013 |
Last Update Date | 24/06/2019 |