Provider Demographics
NPI:1548676448
Name:PANDYA, TEJAS MAHENDRAKUMAR
Entity type:Individual
Prefix:
First Name:TEJAS
Middle Name:MAHENDRAKUMAR
Last Name:PANDYA
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 1:631 NEWARK AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2303
Mailing Address - Country:US
Mailing Address - Phone:201-790-5554
Mailing Address - Fax:
Practice Address - Street 1:631 NEWARK AVE FL 3
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2303
Practice Address - Country:US
Practice Address - Phone:201-790-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03634200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist