Provider Demographics
NPI:1295978278
Name:SUBRAMANIAM, CRISTIN DEVIKA (MD)
Entity type:Individual
Prefix:DR
First Name:CRISTIN
Middle Name:DEVIKA
Last Name:SUBRAMANIAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 EWING ST
Mailing Address - Street 2:SUITE C-15
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2757
Mailing Address - Country:US
Mailing Address - Phone:609-921-2300
Mailing Address - Fax:609-921-9137
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:SUITE C-15
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-921-2300
Practice Address - Fax:609-921-9137
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA09364800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316533Medicare PIN