Individual
INDIRA RADHAKRISHNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
155 JEFFERSON ST, NEWARK, NJ 07105-1706
(908) 490-0036
(908) 490-0067
Mailing address
PO BOX 1923, BLOOMFIELD, NJ 07003-1923
(908) 490-0036
(908) 490-0067
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA03660200
NJ
207L00000X
Anesthesiology Physician
MA36602
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3915701
—
NJ
Enumeration date
12/01/2006
Last updated
10/24/2007
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