Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ01065400 | NJ |
NPI | 1063010940 |
---|---|
Provider Name | Dr. Shruti Satish Patel |
First Address | South Plainfield, NJ 07080-4437 |
Second Address | South Plainfield, NJ 07080-4437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2020 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26NJ01065400 | NJ APN LICENSE (01) | NJ |
26NR18079200 | NJ REGISTERED PROFESSIONAL NURSE LICENSE (01) | NJ |