Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 26NJ00776600 | NJ |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00776600 | NJ |
NPI | 1093229619 |
---|---|
Provider Name | Mittal Patel |
First Address | Jersey City, NJ 07302-6575 |
Second Address | Belleville, NJ 07109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2017 |
Last Update Date | 29/03/2019 |