Basic Information
Provider Information
NPI: 1457768038
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: MEGHAL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD, MPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 22581
Address2:  
City: NEW YORK
State: NY
PostalCode: 100872581
CountryCode: US
TelephoneNumber: 8566696050
FaxNumber: 8565283117
Practice Location
Address1: 34-36 PROGRESS ST
Address2: SUITE A6
City: EDISON
State: NJ
PostalCode: 088201197
CountryCode: US
TelephoneNumber: 9087579555
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/16/2014
LastUpdateDate: 10/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207V00000X25MAO9685900NJY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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