Provider Demographics
NPI:1760589337
Name:NASTA, SUCHETA M (M D)
Entity Type:Individual
Prefix:DR
First Name:SUCHETA
Middle Name:M
Last Name:NASTA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
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Mailing Address - Street 1:90 WASHINGTON ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1050
Mailing Address - Country:US
Mailing Address - Phone:973-676-7192
Mailing Address - Fax:973-676-0525
Practice Address - Street 1:90 WASHINGTON ST
Practice Address - Street 2:SUITE 311
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1050
Practice Address - Country:US
Practice Address - Phone:973-676-7192
Practice Address - Fax:973-676-0525
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA37866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3673502Medicaid
NJ3673502Medicaid