Provider Demographics
NPI:1619225455
Name:DAVDA MEDICAL GROUP LLC
Entity type:Organization
Organization Name:DAVDA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIYATI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-956-7455
Mailing Address - Street 1:1100 CENTENNIAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 CENTENNIAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4152
Practice Address - Country:US
Practice Address - Phone:732-956-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07847200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty