Provider Demographics
NPI:1134664717
Name:PATEL, PURVESH D (APN)
Entity Type:Individual
Prefix:
First Name:PURVESH
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1111
Mailing Address - Country:US
Mailing Address - Phone:856-426-8281
Mailing Address - Fax:
Practice Address - Street 1:701 COOPER RD STE 16
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-8007
Practice Address - Country:US
Practice Address - Phone:856-429-2224
Practice Address - Fax:856-429-1926
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18553800163W00000X
NJ26NJ01066000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NR18553800OtherNJ BOARD OF NURSING