Provider Demographics
NPI:1255071254
Name:CRIDER, NICHOLAS DESAI
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DESAI
Last Name:CRIDER
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 1:18 CENTRE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1501
Mailing Address - Country:US
Mailing Address - Phone:609-860-9111
Mailing Address - Fax:609-860-9311
Practice Address - Street 1:18 CENTRE DR STE 203
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1501
Practice Address - Country:US
Practice Address - Phone:609-860-9111
Practice Address - Fax:609-860-9311
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MD00387000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program