Basic Information
| Provider Information | |||||||||
| NPI: | 1588109326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | JANKI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 US HIGHWAY 46 | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070041591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738823456 | ||||||||
| FaxNumber: | 9738823450 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 US HIGHWAY 46 | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070041591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738823456 | ||||||||
| FaxNumber: | 9738823450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2017 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 08/25/2020 | ||||||||
| NPIReactivationDate: | 06/22/2022 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.