Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 234035 | MA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA08428200 | NJ |
NPI | 1154500304 |
---|---|
Provider Name | Dr. Shubhamvada Nihalani |
First Address | Edison, NJ 08820-1333 |
Second Address | New Brunswick, NJ 08901-1766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 04/02/2009 |