Basic Information
| Provider Information | |||||||||
| NPI: | 1780039404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODDAKASHI | ||||||||
| FirstName: | PALLAVI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 STATE ROUTE 66 FL 3 | ||||||||
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| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077532645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328070877 | ||||||||
| FaxNumber: | 2017511680 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 PROSPECT AVE STE 602 | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519962442 | ||||||||
| FaxNumber: | 2013431045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2016 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | MD047337 | DC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207QH0002X | 0101269635 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.