Provider Demographics
NPI:1811207608
Name:PATEL, KIRTI P (OD)
Entity Type:Individual
Prefix:
First Name:KIRTI
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KIRTI
Other - Middle Name:Y
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH
Mailing Address - Street 1:579 CRANBURY RD
Mailing Address - Street 2:STE I
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5405
Mailing Address - Country:US
Mailing Address - Phone:732-364-4111
Mailing Address - Fax:
Practice Address - Street 1:579 CRANBURY RD
Practice Address - Street 2:SUITE I
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5405
Practice Address - Country:US
Practice Address - Phone:732-307-7933
Practice Address - Fax:732-307-7934
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00628300152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy