Provider Demographics
NPI:1922107440
Name:GEORGE, PREETHI S (MD)
Entity Type:Individual
Prefix:
First Name:PREETHI
Middle Name:S
Last Name:GEORGE
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 1:765 TEANECK RD
Mailing Address - Street 2:SUITE 1 R
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4248
Mailing Address - Country:US
Mailing Address - Phone:201-837-2500
Mailing Address - Fax:201-837-2511
Practice Address - Street 1:765 TEANECK RD
Practice Address - Street 2:SUITE 1 R
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4248
Practice Address - Country:US
Practice Address - Phone:201-837-2500
Practice Address - Fax:201-837-2511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07941700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
096140Medicare ID - Type Unspecified
I46041Medicare UPIN