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General NPI Number Information
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NPI Number | 1720106388
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Entity Type | Organization
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Legal Business Name | NEWBORN TO ADOLESCENT SPECIALISTS
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 24 PLAZA 9
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City | ENGLISHTOWN
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State | NJ
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Zip | 07726
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Country | US
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Telephone | 732-431-0505
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Fax | 732-294-2470
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Provider Business Mailing Address
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Address Line | 24 PLAZA 9
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City | ENGLISHTOWN
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State | NJ
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Zip | 07726
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Country | US
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Telephone | 732-431-0505
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Fax | 732-294-2470
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Authorized Official
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Title or Position | PHYSICIAN - PRESIDENT
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Name | DR. LAKSHMI P NANDIWADA
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Credential | MD
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Telephone | 732-431-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 25MA04546100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | MA51781
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License Number State | NJ
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