1417094897 NPI number — DR. NISHA RANI KRISHAN DAVE MD

Table of content: DR. NISHA RANI KRISHAN DAVE MD (NPI 1417094897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417094897 NPI number — DR. NISHA RANI KRISHAN DAVE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISHAN DAVE
Provider First Name:
NISHA
Provider Middle Name:
RANI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVE
Provider Other First Name:
NISHA
Provider Other Middle Name:
KRISHAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1417094897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 WORCHESTER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON JUNCTION
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08550-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-897-0715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 FIRST AVENUE, ROOM 6D-22
Provider Second Line Business Practice Location Address:
METROPOLITAN HOSPITAL CENTER
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-423-6457
Provider Business Practice Location Address Fax Number:
212-423-7667
Provider Enumeration Date:
02/01/2007

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: 207W00000X , with the licence number:  25MA07066200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 237543 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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