Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 25MA06771600 | NJ |
NPI | 1053388439 |
---|---|
Provider Name | Dr. Sridhar Srinivasan Nambi |
First Address | Livingston, NJ 07039 |
Second Address | Livingston, NJ 07039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 21/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04-3694523 | TAX ID (01) | NJ |
25MA06771600 | LICENSE (01) | NJ |
65-1262400 | TAXID (01) | NJ |
G72162 | (02) | |
P00094173 | RAILROAD MEDICARE PIN (01) | NJ |