Provider Demographics
NPI:1861551608
Name:PATEL, AMI DINESH (OD)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:DINESH
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 1:6 FLORABUNDA LN
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-4530
Mailing Address - Country:US
Mailing Address - Phone:856-829-1748
Mailing Address - Fax:856-848-5657
Practice Address - Street 1:1750 DEPTFORD CENTER RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-5222
Practice Address - Country:US
Practice Address - Phone:856-848-3162
Practice Address - Fax:856-848-5657
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00576300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2689005OtherAETNA
NJ054804QB4Medicare ID - Type Unspecified
NJ2689005OtherAETNA