Provider Demographics
NPI:1639174394
Name:NATARAJAN, SHOBANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOBANA
Middle Name:
Last Name:NATARAJAN
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 1:174 FLEET AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2430
Mailing Address - Country:US
Mailing Address - Phone:732-205-9660
Mailing Address - Fax:
Practice Address - Street 1:904 OAK TREE AVE
Practice Address - Street 2:STE M
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5126
Practice Address - Country:US
Practice Address - Phone:908-757-1414
Practice Address - Fax:908-757-3317
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06910100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1000621400OtherAMERICHOICE OF NJ
2590924OtherGHI
870967000OtherAMERIHEALTH HMO
1989550OtherUNITED HEALTHCARE GROUP
2K3618OtherHEALTHNET
7129105OtherAETNA PPO
3695582OtherAETNA HMO
925481OtherAMERIHEALTH PPO
3502595OtherCIGNA
P2752621OtherOXFROD HEALTH PLAN
020613322OtherHORIZON BCBS OF NJ
1128842OtherHORIZON NJ HEALTH PLAN
216AY1OtherEMPIRE BCBS
NJ8065004Medicaid
H07139Medicare UPIN
1989550OtherUNITED HEALTHCARE GROUP