Provider Demographics
NPI:1326122565
Name:MOORTHY, LAKSHMI N (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:N
Last Name:MOORTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:201-759-6921
Mailing Address - Fax:322-120-7137
Practice Address - Street 1:89 FRENCH STREET
Practice Address - Street 2:SUITE 2300
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-235-4980
Practice Address - Fax:732-235-7088
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07670900208000000X, 2080P0216X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042412Medicaid
084386Medicare ID - Type Unspecified
NJ0042412Medicaid
I18862Medicare UPIN