Healthcare Provider Details

I. General information

NPI: 1174228621
Provider Name (Legal Business Name): NIDHI MISTRY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 STATE ROUTE 33 STE 204
NEPTUNE NJ
07753-4863
US

IV. Provider business mailing address

36 ELDORADO WAY
MONROE TOWNSHIP NJ
08831-4510
US

V. Phone/Fax

Practice location:
  • Phone: 732-455-8559
  • Fax:
Mailing address:
  • Phone: 732-766-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB13234600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: