Provider Demographics
NPI:1376646687
Name:MATE, SHRIKRISHNA KASHINATH
Entity Type:Individual
Prefix:
First Name:SHRIKRISHNA
Middle Name:KASHINATH
Last Name:MATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-458-1177
Mailing Address - Fax:732-458-5942
Practice Address - Street 1:525 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-458-1177
Practice Address - Fax:732-458-5942
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03152100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
011924OtherAETNA
J0918OtherBLUE CROSS HMO
1077539OtherMERCY STATEPLAN