Provider Demographics
NPI:1396066940
Name:NEO DOC OF SWFL PA
Entity type:Organization
Organization Name:NEO DOC OF SWFL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:732-309-1292
Mailing Address - Street 1:1181 S SUMTER BLVD
Mailing Address - Street 2:#311
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2335
Mailing Address - Country:US
Mailing Address - Phone:732-218-6005
Mailing Address - Fax:
Practice Address - Street 1:1181 S SUMTER BLVD
Practice Address - Street 2:#311
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2335
Practice Address - Country:US
Practice Address - Phone:732-218-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101565208000000X, 2080N0001X
2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty