Healthcare Provider Details

I. General information

NPI: 1467287185
Provider Name (Legal Business Name): MAITRI N PADIYA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BRICK RD FL 3
MARLTON NJ
08053-2177
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-6000
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ15144800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ15144800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number26NR17089000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: