Provider Demographics
NPI:1689683542
Name:PATEL, AMRISH (MD)
Entity Type:Individual
Prefix:
First Name:AMRISH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 10TH STREET
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094
Mailing Address - Country:US
Mailing Address - Phone:201-974-1541
Mailing Address - Fax:201-974-1581
Practice Address - Street 1:714 10TH STREET
Practice Address - Street 2:SUITE 6A
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094
Practice Address - Country:US
Practice Address - Phone:201-974-1541
Practice Address - Fax:201-974-1581
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07127500207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59211Medicare UPIN
NJ044005Medicare ID - Type Unspecified