Provider Demographics
NPI:1326117599
Name:HRISHIKESAN, GEETHA (MD)
Entity Type:Individual
Prefix:DR
First Name:GEETHA
Middle Name:
Last Name:HRISHIKESAN
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 1:4 KARNELL CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2947
Mailing Address - Country:US
Mailing Address - Phone:732-548-9667
Mailing Address - Fax:
Practice Address - Street 1:48 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4137
Practice Address - Country:US
Practice Address - Phone:973-744-8511
Practice Address - Fax:973-744-6356
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08140200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine