Provider Demographics
NPI:1164797247
Name:PATEL, NISHANT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NISHANT
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1938
Mailing Address - Country:US
Mailing Address - Phone:609-947-6857
Mailing Address - Fax:
Practice Address - Street 1:1 JOURNAL SQUARE PLZ
Practice Address - Street 2:4TH FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4004
Practice Address - Country:US
Practice Address - Phone:609-947-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical