Healthcare Provider Details

I. General information

NPI: 1043486129
Provider Name (Legal Business Name): SUBHASHINI SUBRAMANIAN MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 POLIFLY RD STE 106
HACKENSACK NJ
07601-1749
US

IV. Provider business mailing address

9 HEMLOCK DR
PARAMUS NJ
07652-3311
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-7617
  • Fax:
Mailing address:
  • Phone: 646-387-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MA08986900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: