Provider Demographics
NPI:1538374590
Name:AGNIHOTRI, VIVEK (MSN, APNC, CIC, CCRN)
Entity type:Individual
Prefix:MR
First Name:VIVEK
Middle Name:
Last Name:AGNIHOTRI
Suffix:
Gender:M
Credentials:MSN, APNC, CIC, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2053
Mailing Address - Country:US
Mailing Address - Phone:973-625-6602
Mailing Address - Fax:
Practice Address - Street 1:25 POCONO RD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2954
Practice Address - Country:US
Practice Address - Phone:973-625-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00009500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health