Provider Demographics
NPI:1114391489
Name:BASKAR, NIRMALA RATNAM (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:NIRMALA
Middle Name:RATNAM
Last Name:BASKAR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2606
Mailing Address - Country:US
Mailing Address - Phone:973-748-5700
Mailing Address - Fax:973-748-5300
Practice Address - Street 1:194 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2606
Practice Address - Country:US
Practice Address - Phone:973-748-5700
Practice Address - Fax:973-748-5300
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00546500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily