Provider Demographics
NPI:1457914814
Name:ATYAM, NEHA
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:ATYAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 RTE 202/206
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1746
Mailing Address - Country:US
Mailing Address - Phone:087-048-7789
Mailing Address - Fax:087-048-1729
Practice Address - Street 1:4491 ROUTE 27
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-8708
Practice Address - Country:US
Practice Address - Phone:609-924-8333
Practice Address - Fax:099-248-6636
Is Sole Proprietor?:No
Enumeration Date:2019-04-20
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00375200213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery