Provider Demographics
NPI:1851814529
Name:PATEL, HEENA M (APN)
Entity Type:Individual
Prefix:
First Name:HEENA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1949
Mailing Address - Country:US
Mailing Address - Phone:973-960-3649
Mailing Address - Fax:
Practice Address - Street 1:19B DELLWOOD LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1551
Practice Address - Country:US
Practice Address - Phone:732-247-7016
Practice Address - Fax:732-247-7016
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00739500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty