Provider Demographics
NPI:1912697640
Name:SUBRAMANIAN, SHIVKUMAR
Entity Type:Individual
Prefix:
First Name:SHIVKUMAR
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1846
Mailing Address - Country:US
Mailing Address - Phone:201-426-0299
Mailing Address - Fax:201-592-4016
Practice Address - Street 1:174 BOULEVARD
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1846
Practice Address - Country:US
Practice Address - Phone:201-426-0299
Practice Address - Fax:201-592-4016
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No251E00000XAgenciesHome Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program