Provider Demographics
NPI:1740257880
Name:PATEL, MONA (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1883
Mailing Address - Country:US
Mailing Address - Phone:201-599-9700
Mailing Address - Fax:201-599-3330
Practice Address - Street 1:70 KINDERKAMACK ROAD
Practice Address - Street 2:SUITE # 201
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630
Practice Address - Country:US
Practice Address - Phone:201-599-9700
Practice Address - Fax:201-599-3330
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA054437002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8787107Medicaid
F75132Medicare UPIN
NJ8787107Medicaid