Individual
DR. DEEPAK SRINIVASAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11-10 5TH ST, FAIR LAWN, NJ 07410-1473
(201) 312-7682
Mailing address
11-10 5TH ST, FAIR LAWN, NJ 07410-1473
(201) 312-7682
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MA06740000
NJ
207RI0011X
Interventional Cardiology Physician
MA06740000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018180
—
NJ
Enumeration date
08/15/2006
Last updated
05/18/2009
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