Provider Demographics
NPI:1851324693
Name:MODI, SMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SMITA
Middle Name:
Last Name:MODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-1625
Mailing Address - Country:US
Mailing Address - Phone:732-283-3311
Mailing Address - Fax:732-283-3525
Practice Address - Street 1:1407 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-1625
Practice Address - Country:US
Practice Address - Phone:732-283-3311
Practice Address - Fax:732-283-3525
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA027778002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2871505Medicaid
NJ2871505Medicaid
NJD18660Medicare UPIN