Provider Demographics
NPI:1407235385
Name:DODIA, TANVI (LAC)
Entity Type:Individual
Prefix:
First Name:TANVI
Middle Name:
Last Name:DODIA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MANILA AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2539
Mailing Address - Country:US
Mailing Address - Phone:312-813-8448
Mailing Address - Fax:
Practice Address - Street 1:425 MANILA AVE FL 1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2539
Practice Address - Country:US
Practice Address - Phone:312-813-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00111200171100000X
NY005493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist