Healthcare Provider Details

I. General information

NPI: 1568754042
Provider Name (Legal Business Name): NISHIL DALSANIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVE
EGG HARBOR TOWNSHIP NJ
08234-5549
US

IV. Provider business mailing address

3600 ROUTE 66
NEPTUNE NJ
07753-2645
US

V. Phone/Fax

Practice location:
  • Phone: 609-404-7345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number280092
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number280092
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDR.0067940
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA11865300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: