Provider Demographics
NPI:1881647188
Name:DELIWALA, TEJAS P (MD)
Entity Type:Individual
Prefix:
First Name:TEJAS
Middle Name:P
Last Name:DELIWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOSPITAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6434
Mailing Address - Country:US
Mailing Address - Phone:732-240-9222
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6434
Practice Address - Country:US
Practice Address - Phone:732-240-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1585592OtherAETNA
NJ4338191OtherCIGNA
NJ0037095Medicaid
NJ1585592OtherAETNA
NJ4338191OtherCIGNA