Provider Demographics
NPI:1174582746
Name:KRISHNAMSETTY, NANDITHA (MD)
Entity type:Individual
Prefix:
First Name:NANDITHA
Middle Name:
Last Name:KRISHNAMSETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOSPITAL PLZ
Mailing Address - Street 2:STE 302
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3095
Mailing Address - Country:US
Mailing Address - Phone:732-360-4077
Mailing Address - Fax:732-360-4078
Practice Address - Street 1:2433 HIGHWAY 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1899
Practice Address - Country:US
Practice Address - Phone:732-360-0287
Practice Address - Fax:732-360-1279
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076274002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6863587OtherAETNA HMO
NJ7302923OtherAETNA PPO
NJ125882Medicare UPIN
NJ6863587OtherAETNA HMO
NJ088572TDXMedicare PIN