Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 25MA07354400 | NJ |
NPI | 1104844778 |
---|---|
Provider Name | Suhas R Patel |
First Address | Ocean, NJ 07712-4077 |
Second Address | Ocean, NJ 07712-4077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 14/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0059757 | (05) | NJ |
H60002 | (02) | NJ |