Provider Demographics
NPI:1053466672
Name:PATEL, AMITA N (MD,)
Entity type:Individual
Prefix:
First Name:AMITA
Middle Name:N
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 1:817 RAHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-2212
Mailing Address - Country:US
Mailing Address - Phone:908-353-5750
Mailing Address - Fax:908-355-2452
Practice Address - Street 1:817 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-2212
Practice Address - Country:US
Practice Address - Phone:908-353-5750
Practice Address - Fax:908-355-2452
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA039598002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0433705Medicaid
NJE13863Medicare UPIN