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General NPI Number Information
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NPI Number | 1104236298
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Entity Type | Individual
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Provider Name | NIKITA GANATRA
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Gender | Female
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 530 NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3654
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Country | US
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Telephone | 732-324-5104
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3581
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City | JERSEY CITY
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State | NJ
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Zip | 07303-3581
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Country | US
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Telephone | 732-343-2551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MA20009400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A162855
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License Number State | CA
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