Healthcare Provider Details

I. General information

NPI: 1093452401
Provider Name (Legal Business Name): ASHA GOPINATH HARIKUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07306-5804
US

IV. Provider business mailing address

540 MABIE ST
NEW MILFORD NJ
07646-2011
US

V. Phone/Fax

Practice location:
  • Phone: 201-451-1601
  • Fax:
Mailing address:
  • Phone: 551-580-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01309400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: