Provider Demographics
NPI:1174755144
Name:IYER, DEEPA B (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:B
Last Name:IYER
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 1:120 ALBANY STREET
Mailing Address - Street 2:TOWER 2, 7TH FLOOR
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2126
Mailing Address - Country:US
Mailing Address - Phone:732-937-8537
Mailing Address - Fax:732-937-8941
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PLACE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08903
Practice Address - Country:US
Practice Address - Phone:732-235-8695
Practice Address - Fax:732-235-8696
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08360500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0217751Medicaid
NJ171964XPFMedicare PIN
NJ171964BB4Medicare PIN