MEDICARE: PURVI JIGAR PITHWA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	40QA01104300	NJ

General Provider Information

NPI Number	:	1194982751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PURVI JIGAR PITHWA

Provider Business Mailing Address
First Line	:	1804 OAK TREE RD
Second Line	:	STE 2
City	:	EDISON
State	:	NJ
Zip	:	08820-2783
Country	:	US
Telephone Number	:	732-662-1784
Fax Number	:	732-662-1785

Provider Business Practice Location Address
First Line	:	1804 OAK TREE RD
Second Line	:	SUITE 2
City	:	EDISON
State	:	NJ
Zip	:	08820-2783
Country	:	US
Telephone Number	:	732-662-1784
Fax Number	:	732-662-1785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	08/31/2020

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