Provider Demographics
NPI:1659380558
Name:NAKHATE, VISHAKHA VINAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHAKHA
Middle Name:VINAY
Last Name:NAKHATE
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 1:1318 S MAIN RD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6516
Mailing Address - Country:US
Mailing Address - Phone:856-691-8585
Mailing Address - Fax:856-691-8489
Practice Address - Street 1:1318 S. MAIN ROAD
Practice Address - Street 2:BUILDING 1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6516
Practice Address - Country:US
Practice Address - Phone:856-691-8585
Practice Address - Fax:856-692-8489
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07914400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7959873OtherAETNA
FL276373700Medicaid