Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA08811500 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | MD445960 | PA |
NPI | 1093987034 |
---|---|
Provider Name | Mitesh Patel |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Egg Harbor Township, NJ 08234-5549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 10/11/2015 |