Provider Demographics
NPI:1770834525
Name:PATEL, DEVYANG
Entity Type:Individual
Prefix:
First Name:DEVYANG
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 1:17 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4121
Mailing Address - Country:US
Mailing Address - Phone:732-423-0476
Mailing Address - Fax:
Practice Address - Street 1:979 ROUTE 1
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2712
Practice Address - Country:US
Practice Address - Phone:732-545-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02469200183500000X
NY045123-1183500000X
FLPS31326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist