Provider Demographics
NPI:1295993731
Name:NAADIMUTHU, REVATHI (MD)
Entity type:Individual
Prefix:
First Name:REVATHI
Middle Name:
Last Name:NAADIMUTHU
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 1:509 STILLWELLS CORNER RD
Mailing Address - Street 2:STE E5
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2965
Mailing Address - Country:US
Mailing Address - Phone:732-431-9333
Mailing Address - Fax:
Practice Address - Street 1:509 STILLWELLS CORNER RD
Practice Address - Street 2:STE E5
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2965
Practice Address - Country:US
Practice Address - Phone:732-431-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08526400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology