Basic Information
| Provider Information | |||||||||
| NPI: | 1538457338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHARIA | ||||||||
| FirstName: | AMISHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 RIVER RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | EDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070201016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016546397 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 630 W 168TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123052500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MB09983300 | NJ | N | Other Service Providers | Specialist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 174400000X | 54034 | CT | Y | Other Service Providers | Specialist |
No ID Information.