Provider Demographics
NPI:1528219367
Name:CHINIWALA, NIYATI UMESH (MD)
Entity Type:Individual
Prefix:
First Name:NIYATI
Middle Name:UMESH
Last Name:CHINIWALA
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 1:27 S COOKS BRIDGE RD
Mailing Address - Street 2:STE 2-7
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2463
Mailing Address - Country:US
Mailing Address - Phone:732-897-3980
Mailing Address - Fax:732-897-3982
Practice Address - Street 1:19 DAVIS AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-897-3980
Practice Address - Fax:732-897-3982
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09775900207RE0101X
NY003767207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0492141Medicaid
NJ0492141Medicaid