Provider Demographics
NPI:1053786830
Name:PATEL, JAY H
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 73RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-3834
Mailing Address - Country:US
Mailing Address - Phone:201-600-5238
Mailing Address - Fax:
Practice Address - Street 1:104 12TH AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-3004
Practice Address - Country:US
Practice Address - Phone:973-621-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03757200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist