Provider Demographics
NPI:1417284811
Name:PRAJAPATI, VIREL R (PA-C)
Entity Type:Individual
Prefix:
First Name:VIREL
Middle Name:R
Last Name:PRAJAPATI
Suffix:
Gender:M
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 1:1302 ROBERTS WAY
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2061
Mailing Address - Country:US
Mailing Address - Phone:609-217-1847
Mailing Address - Fax:
Practice Address - Street 1:865 STONE ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2742
Practice Address - Country:US
Practice Address - Phone:732-381-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00228300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant