Provider Demographics
NPI:1053968321
Name:PATEL, MAMTA A (APN FNP BC)
Entity type:Individual
Prefix:
First Name:MAMTA
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:APN FNP BC
Other - Prefix:
Other - First Name:MAMTA
Other - Middle Name:R
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN FNP BC
Mailing Address - Street 1:680 DARMODY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4547
Mailing Address - Country:US
Mailing Address - Phone:732-429-2316
Mailing Address - Fax:
Practice Address - Street 1:680 DARMODY AVE
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-0890
Practice Address - Country:US
Practice Address - Phone:732-429-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00930900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1053968321OtherCDS