Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 25MA03287400 | NJ |
NPI | 1659415834 |
---|---|
Provider Name | Dr. Mcdonald Srinivasan |
First Address | Closter, NJ 07624-1013 |
Second Address | Englewood, NJ 07631-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
#CO8176 | (02) | NJ |