Provider Demographics
NPI:1043411085
Name:JHA, DIVYA (DDS)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:JHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 W 62ND ST
Mailing Address - Street 2:APT 6G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7015
Mailing Address - Country:US
Mailing Address - Phone:917-570-9995
Mailing Address - Fax:
Practice Address - Street 1:235 CLOSTER DOCK RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1907
Practice Address - Country:US
Practice Address - Phone:201-768-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023321001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics