Provider Demographics
NPI:1194982751
Name:PITHWA, PURVI JIGAR
Entity type:Individual
Prefix:
First Name:PURVI
Middle Name:JIGAR
Last Name:PITHWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PURVI
Other - Middle Name:BADRINARAYAN
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAPT
Mailing Address - Street 1:1804 OAK TREE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2783
Mailing Address - Country:US
Mailing Address - Phone:732-662-1784
Mailing Address - Fax:732-662-1785
Practice Address - Street 1:1804 OAK TREE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2783
Practice Address - Country:US
Practice Address - Phone:732-662-1784
Practice Address - Fax:732-662-1785
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01104300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ125010YG4Medicare PIN