Provider Demographics
NPI:1760133474
Name:PATEL, MEHUL K
Entity Type:Individual
Prefix:
First Name:MEHUL
Middle Name:K
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 1:35 RONALD DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3814
Mailing Address - Country:US
Mailing Address - Phone:973-968-0975
Mailing Address - Fax:
Practice Address - Street 1:124 DURHAM AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2528
Practice Address - Country:US
Practice Address - Phone:908-548-8224
Practice Address - Fax:908-205-0060
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW00124200183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician