Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 25MA07818500 | NJ |
NPI | 1013908268 |
---|---|
Provider Name | Anuradha R Konkesa |
First Address | Newark, NJ 07107-3000 |
Second Address | Paramus, NJ 07652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 30/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I23829 | (02) |