Provider Demographics
NPI:1528192382
Name:PATEL, NIMISH N (OD)
Entity Type:Individual
Prefix:DR
First Name:NIMISH
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VAN DUYNE CT
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1439
Mailing Address - Country:US
Mailing Address - Phone:973-769-7610
Mailing Address - Fax:
Practice Address - Street 1:550 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1729
Practice Address - Country:US
Practice Address - Phone:973-839-0626
Practice Address - Fax:973-839-7317
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ144833Medicare PIN
NJU59295Medicare UPIN