Provider Demographics
NPI:1457405524
Name:GAJADHAR, NICOLE JACQUELINE (RPA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JACQUELINE
Last Name:GAJADHAR
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PELHAM RD
Mailing Address - Street 2:APT 4D
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3139
Mailing Address - Country:US
Mailing Address - Phone:914-667-4095
Mailing Address - Fax:
Practice Address - Street 1:5 GRACE CHURCH ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4911
Practice Address - Country:US
Practice Address - Phone:914-937-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011033-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical