Provider Demographics
NPI:1992317267
Name:PATEL, CHARMI Y
Entity type:Individual
Prefix:
First Name:CHARMI
Middle Name:Y
Last Name:PATEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WINANS AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3311
Mailing Address - Country:US
Mailing Address - Phone:781-827-1434
Mailing Address - Fax:
Practice Address - Street 1:486 SCHOOLEYS MOUNTAIN RD STE 2A
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4000
Practice Address - Country:US
Practice Address - Phone:908-852-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01916800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000Medicaid
NJ0000000000000Medicaid
000000000000000000OtherALL PRIVATE INSURANCES