Provider Demographics
NPI:1225290463
Name:CHANDIWALA-MODY, PRITI (DO)
Entity Type:Individual
Prefix:DR
First Name:PRITI
Middle Name:
Last Name:CHANDIWALA-MODY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 E 29TH ST
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4654
Mailing Address - Country:US
Mailing Address - Phone:201-858-7341
Mailing Address - Fax:
Practice Address - Street 1:29 E 29TH ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4654
Practice Address - Country:US
Practice Address - Phone:201-858-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010170222085R0202X
NJ25MB088649002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology