Provider Demographics
NPI:1013600717
Name:TIWARI, KUMUDHATI
Entity Type:Individual
Prefix:
First Name:KUMUDHATI
Middle Name:
Last Name:TIWARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BERGEN AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3954
Mailing Address - Country:US
Mailing Address - Phone:302-747-0687
Mailing Address - Fax:
Practice Address - Street 1:977 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1843
Practice Address - Country:US
Practice Address - Phone:173-241-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02974100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist