Provider Demographics
NPI:1831116284
Name:MANKIKAR, DURGESH (MD)
Entity Type:Individual
Prefix:
First Name:DURGESH
Middle Name:
Last Name:MANKIKAR
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 1:40 STIRLING RD
Mailing Address - Street 2:STE., 205
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5900
Mailing Address - Country:US
Mailing Address - Phone:990-876-9108
Mailing Address - Fax:908-769-4139
Practice Address - Street 1:40 STIRLING RD
Practice Address - Street 2:STE., 205
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-5900
Practice Address - Country:US
Practice Address - Phone:908-769-1084
Practice Address - Fax:908-769-4139
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04424207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0314307Medicaid
NJ449118Medicare PIN
NJ227158Medicare PIN
NJ0314307Medicaid