Provider Demographics
NPI:1790916641
Name:TRIVEDI, AMIT V (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:V
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 HARRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-2810
Mailing Address - Country:US
Mailing Address - Phone:201-701-0774
Mailing Address - Fax:
Practice Address - Street 1:290 HARRISTOWN RD
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-2810
Practice Address - Country:US
Practice Address - Phone:609-379-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00575500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor