Provider Demographics
NPI:1790725455
Name:PATEL, SEJAL N (PA-C)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SEJAL
Other - Middle Name:N
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:33 CLYDE RD
Mailing Address - Street 2:SUITES 105-106
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5032
Mailing Address - Country:US
Mailing Address - Phone:732-873-6868
Mailing Address - Fax:732-873-6869
Practice Address - Street 1:33 CLYDE RD
Practice Address - Street 2:SUITES 105-106
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5032
Practice Address - Country:US
Practice Address - Phone:732-873-6868
Practice Address - Fax:732-873-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP89500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q66792Medicare UPIN
NJ099203Medicare ID - Type Unspecified