MEDICARE: EREKLE NINIASHVILI

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	174H00000X	Health Educator	3003674370	NJ

General Provider Information

NPI Number	:	1518809607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EREKLE NINIASHVILI

Provider Business Mailing Address
First Line	:	744 UNDERCLIFF AVE APT 2
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 UNDERCLIFF AVE APT 2
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1453
Country	:	US
Telephone Number	:	551-202-9079
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ EREKLE NINIASHVILI ” Practice Location

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