Basic Information
| Provider Information | |||||||||
| NPI: | 1982764015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | JAIMINI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N., C.N.M. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 275 HOBART ST | ||||||||
| Address2: | |||||||||
| City: | PERTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088613396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323769333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 275 HOBART ST | ||||||||
| Address2: | |||||||||
| City: | PERTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323769333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 25ME00032300 | NJ | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 0260665 | 05 | NJ | MEDICAID |