Provider Demographics
NPI:1114182433
Name:PANDYA, DHYANESH C
Entity Type:Individual
Prefix:DR
First Name:DHYANESH
Middle Name:C
Last Name:PANDYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 ROSEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1690
Mailing Address - Country:US
Mailing Address - Phone:484-526-6643
Mailing Address - Fax:484-526-4658
Practice Address - Street 1:185 ROSEBERRY ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1690
Practice Address - Country:US
Practice Address - Phone:484-526-6643
Practice Address - Fax:484-526-4658
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08932000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ220569Medicare PIN