Healthcare Provider Details

I. General information

NPI: 1679956981
Provider Name (Legal Business Name): ARJUN K THEERTHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 BORDENTOWN AVE
PARLIN NJ
08859-1851
US

IV. Provider business mailing address

601 N 30TH ST - CU DEPARTMENT OF INTERNAL MEDICINE
OMAHA NE
68131
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-0400
  • Fax:
Mailing address:
  • Phone: 402-717-0800
  • Fax: 402-280-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA10280200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA10280200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: