=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669027470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILESH CHHEDA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2019
-----------------------------------------------------
Last Update Date | 08/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 S ORANGE AVE STE 105
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-803-0901
-----------------------------------------------------
Fax | 973-808-1991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 SYCAMORE AVE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-803-0901
-----------------------------------------------------
Fax | 973-808-1991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HP0291900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------