Provider Demographics
NPI:1568600385
Name:SUKETU NANAVATI MD PA
Entity Type:Organization
Organization Name:SUKETU NANAVATI MD PA
Other - Org Name:CAPE HEART CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKETU
Authorized Official - Middle Name:H
Authorized Official - Last Name:NANAVATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-465-7517
Mailing Address - Street 1:2 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1939
Mailing Address - Country:US
Mailing Address - Phone:609-465-7517
Mailing Address - Fax:609-465-2448
Practice Address - Street 1:2 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1939
Practice Address - Country:US
Practice Address - Phone:609-465-7517
Practice Address - Fax:609-465-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53160Medicare UPIN