Provider Demographics
NPI:1417396771
Name:PATEL, PRACHI H (DPM)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:H
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 MANTUA PIKE STE 8
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1141
Mailing Address - Country:US
Mailing Address - Phone:856-384-1333
Mailing Address - Fax:856-384-1297
Practice Address - Street 1:722 MANTUA PIKE STE 8
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1141
Practice Address - Country:US
Practice Address - Phone:856-384-1333
Practice Address - Fax:856-384-1297
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274346-211213E00000X
NJ25MD00330400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist