Provider Demographics
NPI:1700983061
Name:DATWANI, NEETA D (MD)
Entity Type:Individual
Prefix:DR
First Name:NEETA
Middle Name:D
Last Name:DATWANI
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-2921
Mailing Address - Fax:
Practice Address - Street 1:218 C SUNSET ROAD
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046
Practice Address - Country:US
Practice Address - Phone:609-877-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
00100758402OtherAMERICHOICE
1507354OtherCIGNA
P3669142OtherOXFORD HEALTH PLAN
NJ0097471Medicaid
60023453OtherHORIZON NJ HEALTH
1166760OtherAETNA
2707954000OtherAMERIHEALTH, HMO, KEYSTONE, IBC
42420OtherUNIVERSITY HEALTHCARE
099823 AVVMedicare PIN
1507354OtherCIGNA