Provider Demographics
NPI:1417284753
Name:PATEL, KEYA (RD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:KEYA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CARNATION RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5335
Mailing Address - Country:US
Mailing Address - Phone:609-992-4776
Mailing Address - Fax:609-371-0603
Practice Address - Street 1:2103 KLOCKNER ROAD
Practice Address - Street 2:PATEL MEDICAL GROUP
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-992-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ966656133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered