Healthcare Provider Details

I. General information

NPI: 1427574805
Provider Name (Legal Business Name): SHRUTI RAHIL JOGANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUMMIT AVE
HACKENSACK NJ
07601-1550
US

IV. Provider business mailing address

151 ALPINE DR
CLOSTER NJ
07624-2811
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-9030
  • Fax:
Mailing address:
  • Phone: 312-622-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03007500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: