Provider Demographics
NPI:1184947343
Name:JITENDRA J. LODHAVIA M.D. , P.A.
Entity type:Organization
Organization Name:JITENDRA J. LODHAVIA M.D. , P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JITENDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LODHAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-488-4420
Mailing Address - Street 1:71 SUMMIT AVE
Mailing Address - Street 2:GROUND FLOOR, REAR ENTRANCE
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1262
Mailing Address - Country:US
Mailing Address - Phone:201-488-4420
Mailing Address - Fax:201-488-7570
Practice Address - Street 1:71 SUMMIT AVE
Practice Address - Street 2:GROUND FLOOR, REAR ENTRANCE
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1262
Practice Address - Country:US
Practice Address - Phone:201-488-4420
Practice Address - Fax:201-488-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02730900207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ460897Medicare UPIN