Provider Demographics
NPI:1609476761
Name:UTHUP, REMYA
Entity Type:Individual
Prefix:
First Name:REMYA
Middle Name:
Last Name:UTHUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MAIN ST APT 418
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5745
Mailing Address - Country:US
Mailing Address - Phone:631-793-8688
Mailing Address - Fax:
Practice Address - Street 1:240 MAIN ST APT 418
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5745
Practice Address - Country:US
Practice Address - Phone:631-793-8688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309885363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health