Provider Demographics
NPI:1629635255
Name:MODI, DEVAS J (DO)
Entity type:Individual
Prefix:
First Name:DEVAS
Middle Name:J
Last Name:MODI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1680 ROUTE 23 STE 250
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7520
Mailing Address - Country:US
Mailing Address - Phone:873-346-1122
Mailing Address - Fax:973-633-9922
Practice Address - Street 1:1680 ROUTE 23 STE 250
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7520
Practice Address - Country:US
Practice Address - Phone:873-346-1122
Practice Address - Fax:973-633-9922
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2024-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA121397002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine