Provider Demographics
NPI:1821488263
Name:KOLADIYA, MAHESH PARASHOTAM
Entity Type:Individual
Prefix:MR
First Name:MAHESH
Middle Name:PARASHOTAM
Last Name:KOLADIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 64TH ST
Mailing Address - Street 2:APT # A1
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-3042
Mailing Address - Country:US
Mailing Address - Phone:201-875-2920
Mailing Address - Fax:917-962-4451
Practice Address - Street 1:101, 64TH STREET
Practice Address - Street 2:APT # A1
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5460
Practice Address - Country:US
Practice Address - Phone:201-875-2920
Practice Address - Fax:917-962-4451
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03626400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist