Provider Demographics
NPI:1871138909
Name:PATEL, NITISHA P
Entity type:Individual
Prefix:
First Name:NITISHA
Middle Name:P
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 1:10 DOYLE LN
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-5544
Mailing Address - Country:US
Mailing Address - Phone:908-463-8481
Mailing Address - Fax:
Practice Address - Street 1:237 AVENUE E
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3714
Practice Address - Country:US
Practice Address - Phone:201-455-3144
Practice Address - Fax:201-455-5290
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023848225X00000X
NJ46TR00897200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist