1427034966 NPI number — DR. ANIL PURSHOTAM ARDESHNA DMD

Table of content: DR. ANIL PURSHOTAM ARDESHNA DMD (NPI 1427034966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427034966 NPI number — DR. ANIL PURSHOTAM ARDESHNA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARDESHNA
Provider First Name:
ANIL
Provider Middle Name:
PURSHOTAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427034966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 BERGEN STREET, ROOM 712C
Provider Second Line Business Mailing Address:
UMDNJ-NEW JERSEY DENTAL
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-972-1892
Provider Business Mailing Address Fax Number:
973-972-0526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 BERGEN STREET
Provider Second Line Business Practice Location Address:
UMDNJ-NEW JERSEY DENTAL SCHOOL- ROOM
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-2495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-4729
Provider Business Practice Location Address Fax Number:
973-972-0526
Provider Enumeration Date:
12/16/2005

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: 1223X0400X , with the licence number:  DI01783700 , 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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