Healthcare Provider Details

I. General information

NPI: 1609226166
Provider Name (Legal Business Name): NIMIT DHOLAKIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W END AVE APT 2418
NEW YORK NY
10023-7986
US

IV. Provider business mailing address

21 W END AVE APT 2418
NEW YORK NY
10023-7986
US

V. Phone/Fax

Practice location:
  • Phone: 508-423-2347
  • Fax:
Mailing address:
  • Phone: 508-423-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301110363
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number314464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: