Provider Demographics
NPI:1851341382
Name:PATEL, KINNARI K (OD)
Entity Type:Individual
Prefix:DR
First Name:KINNARI
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 MONMOUTH RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLARKSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-1219
Mailing Address - Country:US
Mailing Address - Phone:609-259-2221
Mailing Address - Fax:609-259-2291
Practice Address - Street 1:498 MONMOUTH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08510-1219
Practice Address - Country:US
Practice Address - Phone:609-259-2221
Practice Address - Fax:609-259-2291
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00599700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100951Medicare PIN
NJV09244Medicare UPIN