Provider Demographics
NPI:1902695323
Name:MISTRY, PERVEEN (FNP-C)
Entity type:Individual
Prefix:
First Name:PERVEEN
Middle Name:
Last Name:MISTRY
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SOUTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9734
Mailing Address - Country:US
Mailing Address - Phone:862-324-4672
Mailing Address - Fax:862-324-4672
Practice Address - Street 1:16 SOUTHWIND DR
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9734
Practice Address - Country:US
Practice Address - Phone:862-324-4672
Practice Address - Fax:862-324-4672
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15325200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner