Provider Demographics
NPI:1851669154
Name:GANATRA, DINESH
Entity Type:Individual
Prefix:MR
First Name:DINESH
Middle Name:
Last Name:GANATRA
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 1:23 BALTIC ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2726
Mailing Address - Country:US
Mailing Address - Phone:732-516-1767
Mailing Address - Fax:973-623-2260
Practice Address - Street 1:124 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-3015
Practice Address - Country:US
Practice Address - Phone:973-623-1876
Practice Address - Fax:973-623-2260
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00293500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4325702Medicaid