Provider Demographics
NPI:1568754570
Name:PATEL, HARSHIL PRAVEEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HARSHIL
Middle Name:PRAVEEN
Last Name:PATEL
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 MOUNT PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1900
Mailing Address - Country:US
Mailing Address - Phone:973-928-1325
Mailing Address - Fax:
Practice Address - Street 1:50 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1900
Practice Address - Country:US
Practice Address - Phone:973-928-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003258363A00000X
IL085.004019363A00000X
CT23.003041363A00000X
NJ25MP00353600363A00000X
NY017087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant