Healthcare Provider Details

I. General information

NPI: 1265486294
Provider Name (Legal Business Name): DIPAKKUMAR PRAVINCHANDRA PANDYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 ROUTE 31 N STE 2
ANNANDALE NJ
08801-3127
US

IV. Provider business mailing address

331 NEWMAN SPRINGS ROAD BLDG. 2, SUITE 220
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 908-894-7222
  • Fax: 908-894-7128
Mailing address:
  • Phone: 732-807-0877
  • Fax: 201-751-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA08079600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: