Provider Demographics
NPI:1598796963
Name:SRIVASTAVA, TULIKA S (MD)
Entity Type:Individual
Prefix:DR
First Name:TULIKA
Middle Name:S
Last Name:SRIVASTAVA
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 1:2 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3004
Mailing Address - Country:US
Mailing Address - Phone:201-385-4400
Mailing Address - Fax:201-384-7067
Practice Address - Street 1:93 W. PALISADES AVENUE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-567-5000
Practice Address - Fax:201-384-7067
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA072084002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0088366Medicaid
NJ065414BHDMedicare ID - Type Unspecified