Provider Demographics
NPI:1215984141
Name:PAPPAS, NADINE C (MD)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:C
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:PAPPAS-WILKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:50 NEWARK AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1185
Mailing Address - Country:US
Mailing Address - Phone:973-844-1000
Mailing Address - Fax:973-844-9202
Practice Address - Street 1:50 NEWARK AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1185
Practice Address - Country:US
Practice Address - Phone:973-844-1000
Practice Address - Fax:973-844-9202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA056105208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6425500Medicaid
NJH41457Medicare UPIN
NJ049130PXGMedicare ID - Type Unspecified