Provider Demographics
NPI:1760179659
Name:SUBBIAH, MINDY NOEL (CRNP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:NOEL
Last Name:SUBBIAH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:NOEL
Other - Last Name:BICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 ROUTE 70 E STE 201
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2335
Mailing Address - Country:US
Mailing Address - Phone:609-451-2020
Mailing Address - Fax:
Practice Address - Street 1:733 ROUTE 70 E STE 201
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2335
Practice Address - Country:US
Practice Address - Phone:215-746-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027227363LF0000X
NJ26NJ14869700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily