Provider Demographics
NPI:1902458078
Name:BHOJAK, NISARG J
Entity Type:Individual
Prefix:
First Name:NISARG
Middle Name:J
Last Name:BHOJAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-1458
Mailing Address - Country:US
Mailing Address - Phone:610-236-0911
Mailing Address - Fax:
Practice Address - Street 1:1220 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-1458
Practice Address - Country:US
Practice Address - Phone:610-236-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03992800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1295082709OtherPA