Provider Demographics
NPI:1750613444
Name:VAIDYA-KANE, SHRUTI ANIRUDDHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:ANIRUDDHA
Last Name:VAIDYA-KANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 2ND ST APT 811
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4902
Mailing Address - Country:US
Mailing Address - Phone:917-557-1959
Mailing Address - Fax:
Practice Address - Street 1:23 WARREN ST STE 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2447
Practice Address - Country:US
Practice Address - Phone:212-355-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0101491223G0001X
NY056624-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice