Provider Demographics
NPI:1912989757
Name:USHAPANICKER MDLLC
Entity Type:Organization
Organization Name:USHAPANICKER MDLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:USHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PANICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-744-9288
Mailing Address - Street 1:2 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2551
Mailing Address - Country:US
Mailing Address - Phone:732-744-9288
Mailing Address - Fax:
Practice Address - Street 1:2 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2551
Practice Address - Country:US
Practice Address - Phone:732-744-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ10202700OtherHORIZON NJ HEALTH
NJLP195OtherOXFORD
NJ1K6836OtherHEALTHNET
NJ2421743OtherAETNA
NJ8371202Medicaid
NJLP195OtherOXFORD
NJ8371202Medicaid