Provider Demographics
NPI:1508934712
Name:TANDON, PRITI P (PA)
Entity Type:Individual
Prefix:
First Name:PRITI
Middle Name:P
Last Name:TANDON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3060
Mailing Address - Country:US
Mailing Address - Phone:908-526-8668
Mailing Address - Fax:908-231-6781
Practice Address - Street 1:225 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3060
Practice Address - Country:US
Practice Address - Phone:908-526-8668
Practice Address - Fax:908-231-6781
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00171000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant