Basic Information
| Provider Information | |||||||||
| NPI: | 1033608435 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PATEL | ||||||||
| FirstName: | SIDDHI | ||||||||
| MiddleName: | KAUSHIK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4623 NEW BRUNSWICK AVE | ||||||||
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| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088543840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329258108 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 POCONO RD | ||||||||
| Address2: | |||||||||
| City: | DENVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078342954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736256000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2018 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.