Provider Demographics
NPI:1992174874
Name:NISRIN Q. DAHODWALA MD PC
Entity type:Organization
Organization Name:NISRIN Q. DAHODWALA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NISRIN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:DAHODWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-567-7882
Mailing Address - Street 1:290 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1855
Mailing Address - Country:US
Mailing Address - Phone:609-567-7882
Mailing Address - Fax:
Practice Address - Street 1:290 N WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1855
Practice Address - Country:US
Practice Address - Phone:609-567-7882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00576000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty