Provider Demographics
NPI:1275634701
Name:NANGIA, SUSHMA RANI (MD)
Entity Type:Individual
Prefix:MS
First Name:SUSHMA
Middle Name:RANI
Last Name:NANGIA
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 1:555 NORTH AVE
Mailing Address - Street 2:APT. 10 S
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2404
Mailing Address - Country:US
Mailing Address - Phone:201-967-4000
Mailing Address - Fax:201-967-4187
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:201-967-4187
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062438208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7351704Medicaid
NJ7351704Medicaid
NJNA000592Medicare ID - Type Unspecified