Provider Demographics
NPI:1841966348
Name:K RATKALKAR & E MEZIC M D P A
Entity type:Organization
Organization Name:K RATKALKAR & E MEZIC M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:
Authorized Official - Last Name:RATKALKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-679-9950
Mailing Address - Street 1:26 THROCKMORTON LN
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2578
Mailing Address - Country:US
Mailing Address - Phone:732-679-9961
Mailing Address - Fax:732-679-9957
Practice Address - Street 1:26 THROCKMORTON LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2578
Practice Address - Country:US
Practice Address - Phone:732-679-9961
Practice Address - Fax:732-679-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1437218435Other1437218435