Healthcare Provider Details

I. General information

NPI: 1174586739
Provider Name (Legal Business Name): SRIDHAR KAUSHIK M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ROBERT WOOD JOHNSON PLACE ROBERT WOOD JOHNSON MEDICAL GROUP, DEPT OF PEDIATRICS
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

1232 TOWN CT N
LAWRENCEVILLE NJ
08648-4708
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7887
  • Fax:
Mailing address:
  • Phone: 609-799-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD419642
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA08531200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: