Healthcare Provider Details

I. General information

NPI: 1528219367
Provider Name (Legal Business Name): NIYATI UMESH CHINIWALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 6
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

27 S COOKS BRIDGE RD STE 2-7
JACKSON NJ
08527-2463
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-3980
  • Fax: 732-897-3982
Mailing address:
  • Phone: 732-897-3980
  • Fax: 732-897-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA09775900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: