Provider Demographics
NPI:1144606054
Name:DIWALI LLC
Entity Type:Organization
Organization Name:DIWALI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARIND
Authorized Official - Middle Name:
Authorized Official - Last Name:OZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-216-9295
Mailing Address - Street 1:1625 ANDERSON AVE
Mailing Address - Street 2:ROOM 203
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 ANDERSON AVE
Practice Address - Street 2:ROOM 203
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2748
Practice Address - Country:US
Practice Address - Phone:201-224-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082843002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty