Provider Demographics
NPI:1750527578
Name:DAVE, NISHA DAVENDRA (DO)
Entity type:Individual
Prefix:DR
First Name:NISHA
Middle Name:DAVENDRA
Last Name:DAVE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1237
Mailing Address - Country:US
Mailing Address - Phone:973-615-7569
Mailing Address - Fax:
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:ST JOSEPHS REGIONAL MEDICAL CENTER, DEPT. ANESTHESIA
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08973500207L00000X
FLOS12052207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology