Healthcare Provider Details

I. General information

NPI: 1760372403
Provider Name (Legal Business Name): ADITYA RADHAKRISHNAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 PARKWAY AVE STE 105
EWING NJ
08628-3018
US

IV. Provider business mailing address

2107 GOLDFINCH BLVD UNIT 430
PRINCETON NJ
08540-6875
US

V. Phone/Fax

Practice location:
  • Phone: 646-494-7652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADITYA RADHAKRISHNAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 646-494-7652