Provider Demographics
NPI:1326231242
Name:KAKKILAYA, HARSHILA (MD)
Entity Type:Individual
Prefix:
First Name:HARSHILA
Middle Name:
Last Name:KAKKILAYA
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 1:499 BECKETT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1766
Mailing Address - Country:US
Mailing Address - Phone:856-241-2090
Mailing Address - Fax:856-241-2099
Practice Address - Street 1:499 BECKETT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1766
Practice Address - Country:US
Practice Address - Phone:856-241-2090
Practice Address - Fax:856-241-2099
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08271600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0151955Medicaid
NJ0151955Medicaid