Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 25MA10871500 | NJ |
NPI | 1316320864 |
---|---|
Provider Name | Ketan Patel |
First Address | Brick, NJ 08724-3268 |
Second Address | Brick, NJ 08724-3268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2015 |
Last Update Date | 23/01/2021 |