Provider Demographics
NPI:1811591647
Name:PATEL, RUDRA SAMIR
Entity Type:Individual
Prefix:
First Name:RUDRA
Middle Name:SAMIR
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 1:521 RARITAN ST
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1442
Mailing Address - Country:US
Mailing Address - Phone:732-838-0446
Mailing Address - Fax:
Practice Address - Street 1:521 RARITAN ST
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-1442
Practice Address - Country:US
Practice Address - Phone:732-838-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04138100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist