Provider Demographics
NPI:1710226568
Name:KUMAR, NISHA IYER (MD)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:IYER
Last Name:KUMAR
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 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-291-6818
Mailing Address - Fax:856-291-6819
Practice Address - Street 1:175 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-914-6180
Practice Address - Fax:609-914-9182
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09273000208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0377171Medicaid
NJ0377171Medicaid