Provider Demographics
NPI:1891930947
Name:PRABHURAM, NAGARATHNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NAGARATHNA
Middle Name:
Last Name:PRABHURAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-331-3046
Mailing Address - Fax:732-960-3720
Practice Address - Street 1:2864 RTE 27
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-940-4134
Practice Address - Fax:732-960-3720
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08471400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics