Provider Demographics
NPI:1255119798
Name:PATEL, PALAK JITENDRAKUMAR
Entity type:Individual
Prefix:
First Name:PALAK
Middle Name:JITENDRAKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CLEVELAND AVE APT B
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1307
Mailing Address - Country:US
Mailing Address - Phone:551-799-8413
Mailing Address - Fax:
Practice Address - Street 1:209 CLEVELAND AVE APT B
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1307
Practice Address - Country:US
Practice Address - Phone:551-799-8413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program