Provider Demographics
NPI:1477739290
Name:PATRAWALLA M.D. P.A.
Entity Type:Organization
Organization Name:PATRAWALLA M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRISH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATRAWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-763-4120
Mailing Address - Street 1:96 MILLBURN AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1944
Mailing Address - Country:US
Mailing Address - Phone:973-763-4120
Mailing Address - Fax:973-763-1713
Practice Address - Street 1:96 MILLBURN AVE
Practice Address - Street 2:STE 203
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1944
Practice Address - Country:US
Practice Address - Phone:973-763-4120
Practice Address - Fax:973-763-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54323Medicare UPIN