Provider Demographics
NPI:1174586739
Name:KAUSHIK, SRIDHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:
Last Name:KAUSHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 TOWN CT N
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4708
Mailing Address - Country:US
Mailing Address - Phone:609-799-8213
Mailing Address - Fax:
Practice Address - Street 1:ONE ROBERT WOOD JOHNSON PLACE
Practice Address - Street 2:ROBERT WOOD JOHNSON MEDICAL GROUP, DEPT OF PEDIATRICS
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-235-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4196422080N0001X
NJ25MA085312002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8918601Medicaid