Provider Demographics
NPI:1376521443
Name:JOBANPUTRA, NISHITH KISHOR (DO, MPH, MTM&H)
Entity Type:Individual
Prefix:DR
First Name:NISHITH
Middle Name:KISHOR
Last Name:JOBANPUTRA
Suffix:
Gender:M
Credentials:DO, MPH, MTM&H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 DISCOVERY DR
Practice Address - Street 2:PV DEPT, BLDG 45, RM 238
Practice Address - City:SWIFTWATER
Practice Address - State:PA
Practice Address - Zip Code:18370-9100
Practice Address - Country:US
Practice Address - Phone:570-895-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022011232083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine