Provider Demographics
NPI:1801816251
Name:RANDHAWA, PREET (MD)
Entity Type:Individual
Prefix:
First Name:PREET
Middle Name:
Last Name:RANDHAWA
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 1:520 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4147
Mailing Address - Country:US
Mailing Address - Phone:908-587-9300
Mailing Address - Fax:
Practice Address - Street 1:520 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4147
Practice Address - Country:US
Practice Address - Phone:908-587-9300
Practice Address - Fax:908-587-1901
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA074505207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8966001Medicaid
NJ064089Medicare ID - Type Unspecified
NJH24271Medicare UPIN