Provider Demographics
NPI:1780010819
Name:PATEL, SIDDHI J (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:SIDDHI
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ROCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2328
Mailing Address - Country:US
Mailing Address - Phone:862-703-8647
Mailing Address - Fax:
Practice Address - Street 1:124 ROCK HILL RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2328
Practice Address - Country:US
Practice Address - Phone:862-703-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY