Provider Demographics
NPI:1275551103
Name:VARSHNEYA, NIKITA (MD)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:VARSHNEYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2557
Mailing Address - Country:US
Mailing Address - Phone:732-396-0080
Mailing Address - Fax:
Practice Address - Street 1:29 BROADWAY
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2557
Practice Address - Country:US
Practice Address - Phone:732-396-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07411800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9076000Medicaid
NJH80376Medicare UPIN
NJ9076000Medicaid