Provider Demographics
NPI:1639381684
Name:LONDHE, NIVEDITA REVANKAR (LAC)
Entity Type:Individual
Prefix:MISS
First Name:NIVEDITA
Middle Name:REVANKAR
Last Name:LONDHE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:NITA
Other - Middle Name:VIDYADHAR
Other - Last Name:REVANKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:41 WOODHILL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4661
Mailing Address - Country:US
Mailing Address - Phone:732-662-0539
Mailing Address - Fax:
Practice Address - Street 1:1323 ROUTE 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-662-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00041000171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist