Basic Information
Provider Information | |||||||||
NPI: | 1144532771 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | R. SWAMI NATHAN, MD PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3 BROOKSHIRE DR | ||||||||
Address2: |   | ||||||||
City: | CEDAR GROVE | ||||||||
State: | NJ | ||||||||
PostalCode: | 070091116 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9732398373 | ||||||||
FaxNumber: | 9732398403 | ||||||||
Practice Location | |||||||||
Address1: | 3 BROOKSHIRE DR | ||||||||
Address2: |   | ||||||||
City: | CEDAR GROVE | ||||||||
State: | NJ | ||||||||
PostalCode: | 070091116 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9732398373 | ||||||||
FaxNumber: | 9732398403 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2010 | ||||||||
LastUpdateDate: | 07/12/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NATHAN | ||||||||
AuthorizedOfficialFirstName: | R. | ||||||||
AuthorizedOfficialMiddleName: | SWAMI | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 9732398373 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 25MA04907200 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.