Provider Demographics
NPI:1174559207
Name:NAIR, PRABHA J (MD)
Entity type:Individual
Prefix:
First Name:PRABHA
Middle Name:J
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:53 S LAUREL ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1946
Mailing Address - Country:US
Mailing Address - Phone:856-451-4700
Mailing Address - Fax:856-863-5732
Practice Address - Street 1:70 COHANSEY ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1918
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:856-451-0029
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA05991300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG41458Medicare UPIN
NJ097870Medicare ID - Type Unspecified