Provider Demographics
NPI:1770768715
Name:PATEL, POOJA SHETH
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:SHETH
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:POOJA
Other - Middle Name:
Other - Last Name:SHETH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3320 QUAKER BRIDGE MALL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-799-0809
Mailing Address - Fax:609-799-2566
Practice Address - Street 1:3320 QUAKER BRIDGE MALL
Practice Address - Street 2:SUITE 205
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-799-0809
Practice Address - Fax:609-799-2566
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00612600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist