Individual provider Active NPI

Jalpa Patel, PA-C

  • Physician Assistant
  • Clark, NJ
National Provider Identifier
1194025411
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00248000 Issued in NJ
Practice address
1075 Central Ave
Clark, NJ 07066-1116
Phone
(732) 574-1399
NPI assigned
Nov 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00248000 NJ Primary
Medical Physician Assistant 363AM0700X 25MP00248000 NJ

Addresses

Primary practice location

1075 Central Ave
Clark, NJ 07066-1116

Mailing address

1075 Central Ave
Clark, NJ 07066-1116
Phone (732) 574-1399

Other identifiers 1

IdentifierTypeStateIssuer
25MP00248000OtherNJNEW JERSEY PHYSICIAN ASSISTANT ADVISORY COMMITTEE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110601000601 NJ Practitioner - Physician Assistant 8921285826 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00248000NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Clark Dermatology, LLC PastSince May 11, 2025 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jalpa.patel@metroderm.eclinicaldirectplus.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288656000000",
    "number": "1194025411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 CENTRAL AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661116",
            "telephone_number": "732-574-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 CENTRAL AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661116",
            "telephone_number": "732-574-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "JALPA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-02",
        "last_updated": "2010-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00248000",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00248000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW JERSEY PHYSICIAN ASSISTANT ADVISORY COMMITTEE",
            "identifier": "25MP00248000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark, NJ

Sources for this page

Verify at the official NPI Registry.