Provider Demographics
NPI:1780758763
Name:TIKU, MOTI L (MD)
Entity type:Individual
Prefix:
First Name:MOTI
Middle Name:L
Last Name:TIKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 HWY 27 SUITE 2300
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-301-2628
Mailing Address - Fax:732-377-3319
Practice Address - Street 1:1553 HWY 27 SUITE 2300
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-301-2628
Practice Address - Fax:732-377-3319
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04924700207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2304791OtherAETNA
NJP514354OtherOXFORD
NJ0593929-006OtherCIGNA
NJ15679OtherUNIVERSITY HEALTH PLANS
NJ29304OtherBEECH STREET
NJ660001165OtherRR MCR PTAN
NJ0724408Medicaid
NJ1050446OtherHORIZON NJ HEALTH
NJ0078115000OtherAMERICHOICE
NJF04778OtherHEALTHNET
NJ0724408Medicaid
NJ088039Medicare ID - Type Unspecified
NJF04778OtherHEALTHNET
NJ088039Medicare PIN