Provider Demographics
NPI:1528222882
Name:KHADKE, NEELAM (MD)
Entity Type:Individual
Prefix:
First Name:NEELAM
Middle Name:
Last Name:KHADKE
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 1:198 NORTH AVE E
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2469
Mailing Address - Country:US
Mailing Address - Phone:908-653-1001
Mailing Address - Fax:908-653-1037
Practice Address - Street 1:198 NORTH AVE E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2469
Practice Address - Country:US
Practice Address - Phone:908-653-1001
Practice Address - Fax:908-653-1037
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09550700208000000X
IA38391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0503096Medicaid
IA132380003Medicare Oscar/Certification