Provider Demographics
NPI:1437730082
Name:PEDIATRIC RHEUMATOLOGY OF TRI-STATE PA
Entity Type:Organization
Organization Name:PEDIATRIC RHEUMATOLOGY OF TRI-STATE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUHAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RADHAKRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-752-8442
Mailing Address - Street 1:11 BENNINGTON PL
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5701
Mailing Address - Country:US
Mailing Address - Phone:732-354-9660
Mailing Address - Fax:732-752-3957
Practice Address - Street 1:155 STELTON RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3251
Practice Address - Country:US
Practice Address - Phone:732-752-3957
Practice Address - Fax:732-752-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric RheumatologyGroup - Single Specialty