1386633881 NPI number — DR. MEENA NATHAN

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386633881 NPI number — DR. MEENA NATHAN

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NATHAN

Provider First Name:

MEENA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

F

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:

1386633881

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

470 RICHMOND AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MAPLEWOOD

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07040-1416

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

973-763-8542

Provider Business Mailing Address Fax Number:

973-763-8562

Provider First Line Business Practice Location Address:

201 LYONS AVE

Provider Second Line Business Practice Location Address:

L5, CHILDRENS HEART CENTER, NBIMC

Provider Business Practice Location Address City Name:

NEWARK

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07112-2027

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

973-926-4900

Provider Business Practice Location Address Fax Number:

973-926-8206

Provider Enumeration Date:

10/18/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208G00000X , with the licence number:  25MA08144100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 208G00000X , with the licence number: 154879 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 2793166000 . This is a "AMERIHEALTH INSURANCE COM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0137837 . This is a "GROUP HEALTH INCORPORATED" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0116017 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 270120087004 . This is a "QUALCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 60027478 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 7796322 . This is a "AETNA, US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 317484 . This is a "AMERIGROUP,AMERICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 6338708 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 11087001 . This is a "COUNCIL OF AFFORDABLE QUA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 8430U1 . This is a "WELLCHOICE, EMPIRE HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".