Provider Demographics
NPI:1346825379
Name:PATEL, NISHA BHASKAR (PA-C)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:BHASKAR
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 1:111 BRAMBLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751
Mailing Address - Country:US
Mailing Address - Phone:732-395-0251
Mailing Address - Fax:
Practice Address - Street 1:18 NO. THIRD AVE.
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2429
Practice Address - Country:US
Practice Address - Phone:732-431-8266
Practice Address - Fax:732-294-9794
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00601000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant