Provider Demographics
NPI:1124083209
Name:DUREJA, NEETI (DC)
Entity type:Individual
Prefix:
First Name:NEETI
Middle Name:
Last Name:DUREJA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3032
Mailing Address - Country:US
Mailing Address - Phone:203-856-8550
Mailing Address - Fax:203-557-3148
Practice Address - Street 1:337 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3032
Practice Address - Country:US
Practice Address - Phone:203-856-8550
Practice Address - Fax:203-557-3148
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025220249Medicaid
NY010374OtherSTATE LIC NUMBER
NYU93794Medicare UPIN
NYX01Y91Medicare ID - Type Unspecified