Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 68739 | CT |
Y | 2084V0102X | Vascular Neurology | 68739 | CT |
NPI | 1023470721 |
---|---|
Provider Name | Dr. Nishant Kumar Mishra |
First Address | New Haven, CT 06520-8018 |
Second Address | New Haven, CT 06519-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 29/07/2021 |