Provider Demographics
NPI:1003964420
Name:TRIVEDI, MANOJ M (MD)
Entity Type:Individual
Prefix:
First Name:MANOJ
Middle Name:M
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 OLD SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1130
Mailing Address - Country:US
Mailing Address - Phone:908-273-5644
Mailing Address - Fax:908-273-1435
Practice Address - Street 1:802 OLD SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-1130
Practice Address - Country:US
Practice Address - Phone:908-273-5644
Practice Address - Fax:908-273-1435
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05595700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine