Provider Demographics
NPI:1689927246
Name:MARJADI, RIDDHI (CNIM)
Entity Type:Individual
Prefix:
First Name:RIDDHI
Middle Name:
Last Name:MARJADI
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:RIDDHI
Other - Middle Name:
Other - Last Name:GOSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSA,RSA
Mailing Address - Street 1:1991 MARCUS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2062
Mailing Address - Country:US
Mailing Address - Phone:661-564-2690
Mailing Address - Fax:309-454-7348
Practice Address - Street 1:1991 MARCUS AVE STE 108
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2062
Practice Address - Country:US
Practice Address - Phone:661-564-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000344246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist