Provider Demographics
NPI:1932329893
Name:SRIVIDHYA SUBBARAYAN M D PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:SRIVIDHYA SUBBARAYAN M D PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIVIDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBBARAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-834-2592
Mailing Address - Street 1:78 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2524
Mailing Address - Country:US
Mailing Address - Phone:347-834-2592
Mailing Address - Fax:732-791-2761
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:SUITE 2000 B
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3030
Practice Address - Country:US
Practice Address - Phone:609-799-1100
Practice Address - Fax:609-799-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07067800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG87271Medicare UPIN