Provider Demographics
NPI:1053378786
Name:DAHODWALA, NISRIN Q (MD)
Entity type:Individual
Prefix:DR
First Name:NISRIN
Middle Name:Q
Last Name:DAHODWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:290 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1855
Mailing Address - Country:US
Mailing Address - Phone:609-567-7882
Mailing Address - Fax:609-567-3000
Practice Address - Street 1:290 N WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1855
Practice Address - Country:US
Practice Address - Phone:609-567-7882
Practice Address - Fax:609-567-3000
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0578702080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5188202Medicaid