MEDICARE: NICHOLAS DESAI CRIDER

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	390200000X	Student in an Organized Health Care Education/Training Program
2	213E00000X	Podiatrist	25MD00387000	NJ

General Provider Information

NPI Number	:	1255071254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS DESAI CRIDER

Provider Business Mailing Address
First Line	:	510 HAMBURG TPKE STE 108
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2033
Country	:	US
Telephone Number	:	973-925-4111
Fax Number	:	973-925-7711

Provider Business Practice Location Address
First Line	:	510 HAMBURG TPKE STE 108
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2033
Country	:	US
Telephone Number	:	973-925-4111
Fax Number	:	973-925-7711

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

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	05/18/2026

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Directions to “ NICHOLAS DESAI CRIDER ” Practice Location

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