Basic Information
| Provider Information | |||||||||
| NPI: | 1225422546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | ROSHNI | ||||||||
| MiddleName: | RAJENDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 412826 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022412526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108928889 | ||||||||
| FaxNumber: | 4844468005 | ||||||||
| Practice Location | |||||||||
| Address1: | 99 BEAUVOIR AVE | ||||||||
| Address2: | |||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079013533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085222065 | ||||||||
| FaxNumber: | 9085225763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2015 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 25MB11160500 | NJ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.