Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 25MP00615000 | NJ |
NPI | 1073194171 |
---|---|
Provider Name | Amanda Ann Srinivasan |
First Address | Brigantine, NJ 08203-1834 |
Second Address | Northfield, NJ 08225-1631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2021 |
Last Update Date | 05/05/2021 |