Provider Demographics
NPI:1619119583
Name:PATEL-COHEN, MITAL (MD)
Entity Type:Individual
Prefix:
First Name:MITAL
Middle Name:
Last Name:PATEL-COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MITAL
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1417
Mailing Address - Country:US
Mailing Address - Phone:973-376-8500
Mailing Address - Fax:
Practice Address - Street 1:150 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1049
Practice Address - Country:US
Practice Address - Phone:973-775-5156
Practice Address - Fax:973-775-5114
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA254941207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program