Provider Demographics
NPI:1609189711
Name:PATEL, NISHA CHANDRAVADAN (DMD)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:CHANDRAVADAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RIVER CT
Mailing Address - Street 2:APT # 1909
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2101
Mailing Address - Country:US
Mailing Address - Phone:714-906-3675
Mailing Address - Fax:
Practice Address - Street 1:37 HWY 35
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3900
Practice Address - Country:US
Practice Address - Phone:732-544-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024463001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice