Provider Demographics
NPI:1780168195
Name:PATEL, VAISHALI A
Entity type:Individual
Prefix:
First Name:VAISHALI
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HUNTERS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7705
Mailing Address - Country:US
Mailing Address - Phone:201-388-7890
Mailing Address - Fax:
Practice Address - Street 1:1621 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1248
Practice Address - Country:US
Practice Address - Phone:732-465-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22490225X00000X
MA13803225X00000X, 225X00000X
NJ46TR00743400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOTFAN3788689OtherBCBS