Provider Demographics
NPI:1427497841
Name:PATEL, SUSHMA (OD)
Entity type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 HIGHWAY 35 STE 104
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1927
Mailing Address - Country:US
Mailing Address - Phone:732-223-8000
Mailing Address - Fax:732-223-4010
Practice Address - Street 1:2516 HIGHWAY 35 STE 104
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-223-8000
Practice Address - Fax:732-223-4010
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00647500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450197Medicaid