Provider Demographics
NPI:1629399530
Name:PATEL, DAVE
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 RTE 23
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-3105
Mailing Address - Country:US
Mailing Address - Phone:973-875-0148
Mailing Address - Fax:973-875-9944
Practice Address - Street 1:359 RTE 23
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:NJ
Practice Address - Zip Code:07461-3105
Practice Address - Country:US
Practice Address - Phone:973-875-0148
Practice Address - Fax:973-875-9944
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03184900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist