1174755144 NPI number — DR. DEEPA B IYER MD

Table of content: DR. DEEPA B IYER MD (NPI 1174755144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174755144 NPI number — DR. DEEPA B IYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IYER
Provider First Name:
DEEPA
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174755144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 ALBANY STREET
Provider Second Line Business Mailing Address:
TOWER 2, 7TH FLOOR
Provider Business Mailing Address City Name:
NEW BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08901-2126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-937-8537
Provider Business Mailing Address Fax Number:
732-937-8941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ROBERT WOOD JOHNSON PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-235-8695
Provider Business Practice Location Address Fax Number:
732-235-8696
Provider Enumeration Date:
08/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA08360500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0217751 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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