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General NPI Number Information
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NPI Number | 1437730082
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Entity Type | Organization
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Legal Business Name | PEDIATRIC RHEUMATOLOGY OF TRI-STATE PA
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 155 STELTON RD
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City | PISCATAWAY
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State | NJ
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Zip | 08854-3251
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Country | US
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Telephone | 732-752-3957
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Fax | 732-752-3957
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Provider Business Mailing Address
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Address Line | 11 BENNINGTON PL
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City | PISCATAWAY
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State | NJ
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Zip | 08854-5701
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Country | US
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Telephone | 732-354-9660
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Fax | 732-752-3957
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUHAS RADHAKRISHNA
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Credential | MD
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Telephone | 732-752-8442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0216X
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Taxonomy Name | Pediatric Rheumatology Physician
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License Number |
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License Number State |
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