MEDICARE: DR. NUTAN SHIRISH NADKARNI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MA06880000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11590963	OTHER	NJ	CAQH

General Provider Information

NPI Number	:	1659302578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NUTAN SHIRISH NADKARNI M.D.

Provider Business Mailing Address
First Line	:	3826 PARK AVE
Second Line	:	SUITE 101
City	:	EDISON
State	:	NJ
Zip	:	08820-2508
Country	:	US
Telephone Number	:	732-744-9400
Fax Number	:	732-516-0608

Provider Business Practice Location Address
First Line	:	3826 PARK AVE
Second Line	:	SUITE 101
City	:	EDISON
State	:	NJ
Zip	:	08820-2508
Country	:	US
Telephone Number	:	732-744-9400
Fax Number	:	732-516-0608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/04/2013

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