Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 25MA05220800 | NJ |
NPI | 1033150776 |
---|---|
Provider Name | Dr. Bharati Penupatruni |
First Address | Plainsboro, NJ 08536-3030 |
Second Address | Plainsboro, NJ 08536-3030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6404308 | (05) | NJ |
F95422 | (02) | NJ |