1639381684 NPI number — MISS NIVEDITA REVANKAR LONDHE L.AC.

Table of content: MISS NIVEDITA REVANKAR LONDHE L.AC. (NPI 1639381684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639381684 NPI number — MISS NIVEDITA REVANKAR LONDHE L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONDHE
Provider First Name:
NIVEDITA
Provider Middle Name:
REVANKAR
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
L.AC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REVANKAR
Provider Other First Name:
NITA
Provider Other Middle Name:
VIDYADHAR
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639381684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 WOODHILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873-4661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-662-0539
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1323 ROUTE 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-662-0539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  25MZ00041000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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