Healthcare Provider Details

I. General information

NPI: 1437559663
Provider Name (Legal Business Name): PAYAL KSHATRIYA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6418 BERGENLINE AVE
WEST NEW YORK NJ
07093-1621
US

IV. Provider business mailing address

6040 KENNEDY BLVD E APT MF
WEST NEW YORK NJ
07093-3825
US

V. Phone/Fax

Practice location:
  • Phone: 201-868-6400
  • Fax:
Mailing address:
  • Phone: 203-727-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02581900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: