Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA06654800 | NJ |
NPI | 1053382341 |
---|---|
Provider Name | Kavitha Kanuri |
First Address | Somerset, NJ 08873-4109 |
Second Address | Somerset, NJ 08873-4109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 23/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G92748 | (02) | NJ |