Provider Demographics
NPI:1225013600
Name:LODHAVIA, JITENDRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:J
Last Name:LODHAVIA
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 1:71 SUMMIT AVE
Mailing Address - Street 2:GROUND FLOOR,REAR ENTERANCE
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1262
Mailing Address - Country:US
Mailing Address - Phone:201-488-4420
Mailing Address - Fax:201-488-7570
Practice Address - Street 1:71 SUMMIT AVE
Practice Address - Street 2:GROUND FLOOR, REAR ENTRANCE
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1262
Practice Address - Country:US
Practice Address - Phone:201-488-4420
Practice Address - Fax:201-488-7570
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02730900207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3025306Medicaid
NJBP437OtherOXFORD
0K2690OtherHEALTHNET
NJ3025306Medicaid