Provider Demographics
NPI:1609334432
Name:PATEL, DHRUTI Y
Entity Type:Individual
Prefix:
First Name:DHRUTI
Middle Name:Y
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1726
Mailing Address - Country:US
Mailing Address - Phone:732-789-7901
Mailing Address - Fax:
Practice Address - Street 1:3826 PARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2565
Practice Address - Country:US
Practice Address - Phone:848-247-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician