Provider Demographics
NPI:1821016775
Name:NIKITA VARSHNEYA, M.D P.A
Entity Type:Organization
Organization Name:NIKITA VARSHNEYA, M.D P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARSHNEYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-396-0080
Mailing Address - Street 1:29 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2557
Mailing Address - Country:US
Mailing Address - Phone:732-396-0080
Mailing Address - Fax:
Practice Address - Street 1:29 BROADWAY
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2557
Practice Address - Country:US
Practice Address - Phone:732-396-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07411800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9076000Medicaid
NJ9076000Medicaid