Provider Demographics
NPI:1447587746
Name:JAIN, NIKITA
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SUMMERFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1486
Mailing Address - Country:US
Mailing Address - Phone:917-796-5864
Mailing Address - Fax:
Practice Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3701
Practice Address - Country:US
Practice Address - Phone:609-581-6622
Practice Address - Fax:609-585-9885
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01293100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist