Provider Demographics
NPI:1992828420
Name:PATEL, NILESH MANOJ (OD)
Entity Type:Individual
Prefix:DR
First Name:NILESH
Middle Name:MANOJ
Last Name:PATEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6000 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1448
Mailing Address - Country:US
Mailing Address - Phone:201-854-3411
Mailing Address - Fax:201-854-9088
Practice Address - Street 1:6000 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1448
Practice Address - Country:US
Practice Address - Phone:201-854-3411
Practice Address - Fax:201-854-9088
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00535100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist