Provider Demographics
NPI:1871778555
Name:NISRIN Q DAHODWALA MD PC
Entity type:Organization
Organization Name:NISRIN Q DAHODWALA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NISRIN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:DAHODWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-567-7882
Mailing Address - Street 1:8 N WHITE HORSE PIKE
Mailing Address - Street 2:MIDWAY PROFESSIONAL CENTER
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-567-7882
Mailing Address - Fax:609-567-3000
Practice Address - Street 1:8 N WHITE HORSE PIKE
Practice Address - Street 2:MIDWAY PROFESSIONAL CENTER
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037
Practice Address - Country:US
Practice Address - Phone:609-567-7882
Practice Address - Fax:609-567-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA057870208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty