Provider Demographics
NPI:1174119986
Name:PATEL, KHUSHBU K
Entity type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:K
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 1:7 JEGO CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1484
Mailing Address - Country:US
Mailing Address - Phone:413-478-0430
Mailing Address - Fax:
Practice Address - Street 1:8 EDEN AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3856
Practice Address - Country:US
Practice Address - Phone:732-248-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235402183500000X
NJ28RI04100200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist