=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417223033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JITESH TRIVEDI BS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2012
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 WESTWOOD CT
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07059-2704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-542-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 WESTWOOD COURT
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-542-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI02066000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------