Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 25MA08059600 | NJ |
NPI | 1306973870 |
---|---|
Provider Name | Meera Khedkar |
First Address | Cranford, NJ 07016-2158 |
Second Address | Berkeley Heights, NJ 07922-2104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 05/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001430652 | (05) | NJ |
131483 | (02) | NJ |
25MA08059600 | MEDICAL LICENSE (01) | NJ |