Provider Demographics
NPI:1306867478
Name:KULKARNI, PRATIBHA AVINASH (MD)
Entity Type:Individual
Prefix:
First Name:PRATIBHA
Middle Name:AVINASH
Last Name:KULKARNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5009
Mailing Address - Country:US
Mailing Address - Phone:973-564-5227
Mailing Address - Fax:
Practice Address - Street 1:116 MILLBURN AVE
Practice Address - Street 2:SUITE # 108
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1943
Practice Address - Country:US
Practice Address - Phone:973-564-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 41977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1883402Medicaid
NJ1883402Medicaid
NJ454929Medicare ID - Type Unspecified