Basic Information
| Provider Information | |||||||||
| NPI: | 1770768715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | POOJA | ||||||||
| MiddleName: | SHETH | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SHETH | ||||||||
| OtherFirstName: | POOJA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3320 QUAKER BRIDGE MALL | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097990809 | ||||||||
| FaxNumber: | 6097992566 | ||||||||
| Practice Location | |||||||||
| Address1: | 3320 QUAKER BRIDGE MALL | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097990809 | ||||||||
| FaxNumber: | 6097992566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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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 | 152W00000X | 270A00612600 | NJ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.