Provider Demographics
NPI:1770863789
Name:PATEL, RUPA
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5001
Mailing Address - Country:US
Mailing Address - Phone:908-526-8668
Mailing Address - Fax:908-231-6781
Practice Address - Street 1:222 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-5001
Practice Address - Country:US
Practice Address - Phone:908-526-8668
Practice Address - Fax:908-231-6781
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005267363L00000X
NJ26NJ00572600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner