Provider Demographics
NPI:1619035342
Name:THADHANI, RAMCHAND (MD)
Entity Type:Individual
Prefix:
First Name:RAMCHAND
Middle Name:
Last Name:THADHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 S NEW YORK RD
Mailing Address - Street 2:SUITE C 4
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9695
Mailing Address - Country:US
Mailing Address - Phone:609-652-0555
Mailing Address - Fax:609-652-1414
Practice Address - Street 1:28 S NEW YORK RD
Practice Address - Street 2:SUITE C 4
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9695
Practice Address - Country:US
Practice Address - Phone:609-652-0555
Practice Address - Fax:609-652-1414
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06572700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7417403Medicaid
NJ000527Medicare PIN
NJE65672Medicare UPIN