Provider Demographics
NPI:1033503560
Name:PATEL, SWATI B (PA-C)
Entity Type:Individual
Prefix:
First Name:SWATI
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WILLIAMSON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3674
Mailing Address - Country:US
Mailing Address - Phone:908-355-8877
Mailing Address - Fax:908-355-0017
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-355-8877
Practice Address - Fax:908-355-0017
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00364900363AM0700X
PAOA003512363A00000X
PAMA057500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant