Provider Demographics
NPI:1891941449
Name:MODY, KANIKA PRAVIN (MD)
Entity Type:Individual
Prefix:
First Name:KANIKA
Middle Name:PRAVIN
Last Name:MODY
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 1:35 PINE RD
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1342
Mailing Address - Country:US
Mailing Address - Phone:551-804-7679
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE STE 200
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:551-996-4849
Practice Address - Fax:551-996-8089
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249685207R00000X
NJ25MA09537200207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine