=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861232118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. NIDHI GUNDARANIA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2024
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3655 MUNICIPAL DR
-----------------------------------------------------
City | HOKENDAUQUA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-432-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 519 SHARON GARDEN CT
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07095-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-519-5904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS044731
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------