Provider Demographics
NPI:1659302578
Name:NADKARNI, NUTAN SHIRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:NUTAN
Middle Name:SHIRISH
Last Name:NADKARNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRATIMA
Other - Middle Name:VASANT
Other - Last Name:KANTAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:3826 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2508
Mailing Address - Country:US
Mailing Address - Phone:732-744-9400
Mailing Address - Fax:732-516-0608
Practice Address - Street 1:3826 PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2508
Practice Address - Country:US
Practice Address - Phone:732-744-9400
Practice Address - Fax:732-516-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06880000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11590963OtherCAQH