Provider Demographics
NPI:1679540819
Name:PATHAK, PINAKIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PINAKIN
Middle Name:
Last Name:PATHAK
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 1:400 S MAIN ST
Mailing Address - Street 2:SUITE 2R
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2043
Mailing Address - Country:US
Mailing Address - Phone:973-366-1223
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE 2R
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2043
Practice Address - Country:US
Practice Address - Phone:973-366-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06418500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7050305Medicaid
NJG24852Medicare UPIN
NJ892824Medicare PIN
NJ892824ZBZLMedicare PIN
NJ139144Medicare PIN