Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A101007 | CA |
Y | 2080P0216X | Pediatric Rheumatologist | A101007 | CA |
NPI | 1407027097 |
---|---|
Provider Name | Dr. Suhas Radhakrishna |
First Address | Piscataway, NJ 08854-3251 |
Second Address | Piscataway, NJ 08854-3251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2008 |
Last Update Date | 29/11/2021 |