Healthcare Provider Details

I. General information

NPI: 1285262774
Provider Name (Legal Business Name): NISHA BENGALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 REHILL AVE
SOMERVILLE NJ
08876-2519
US

IV. Provider business mailing address

465 SOUTH ST STE 103
MORRISTOWN NJ
07960-6442
US

V. Phone/Fax

Practice location:
  • Phone: 908-685-2899
  • Fax:
Mailing address:
  • Phone: 908-281-1199
  • Fax: 908-281-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA11986800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: