Provider Demographics
NPI:1427023308
Name:PARIKH, PRATIMA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:PRATIMA
Middle Name:D
Last Name:PARIKH
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 1:15 E TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-1622
Mailing Address - Country:US
Mailing Address - Phone:856-767-0320
Mailing Address - Fax:856-767-3536
Practice Address - Street 1:15 E TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1622
Practice Address - Country:US
Practice Address - Phone:856-767-0320
Practice Address - Fax:856-767-3536
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03592400207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1098501Medicaid
NJ1098501Medicaid