Provider Demographics
NPI:1073848651
Name:LAD, PRIYA R (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:R
Last Name:LAD
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:B
Other - Last Name:CHAMPANERIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPNP
Mailing Address - Street 1:101 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3324
Mailing Address - Country:US
Mailing Address - Phone:732-363-6655
Mailing Address - Fax:732-363-6656
Practice Address - Street 1:101 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3324
Practice Address - Country:US
Practice Address - Phone:732-363-6655
Practice Address - Fax:732-363-6656
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00321300363LP0200X
TNRN0000167674363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics