Provider Demographics
NPI:1851452007
Name:KANTHA, BRINDA SRI (DO)
Entity Type:Individual
Prefix:DR
First Name:BRINDA
Middle Name:SRI
Last Name:KANTHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:1125 US HIGHWAY 22 STE 150
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2939
Practice Address - Country:US
Practice Address - Phone:908-722-2033
Practice Address - Fax:908-707-8344
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07930700208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094078Medicare ID - Type Unspecified
NJI04238Medicare UPIN