Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MA08313500 | NJ |
Y | 111NI0900X | Internist | 25MA08313500 | NJ |
N | 207RG0300X | Geriatric Medicine | 25MA08313500 | NJ |
NPI | 1104897370 |
---|---|
Provider Name | Dr. Shanthi Subbiah |
First Address | Laurel Springs, NJ 08021-2769 |
Second Address | Laurel Springs, NJ 08021-2769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 25/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA08313500 | LICENSE (01) | NJ |
8245100 | (05) | NJ |