Healthcare Provider Details

I. General information

NPI: 1780758763
Provider Name (Legal Business Name): MOTI L TIKU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 HWY 27 SUITE 2300
SOMERSET NJ
08873
US

IV. Provider business mailing address

1553 HWY 27 SUITE 2300
SOMERSET NJ
08873
US

V. Phone/Fax

Practice location:
  • Phone: 732-301-2628
  • Fax: 732-377-3319
Mailing address:
  • Phone: 732-301-2628
  • Fax: 732-377-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA04924700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: