Provider Demographics
NPI:1447744453
Name:PATEL, PARTH S (PA-C)
Entity type:Individual
Prefix:
First Name:PARTH
Middle Name:S
Last Name:PATEL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2459
Mailing Address - Country:US
Mailing Address - Phone:732-986-7484
Mailing Address - Fax:
Practice Address - Street 1:10800 KNIGHTS RD STE 210
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4200
Practice Address - Country:US
Practice Address - Phone:215-612-1028
Practice Address - Fax:215-676-7202
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061499363AM0700X
NY022115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical