Individual
DR. KETAKI VAIDHYANATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 BAY AVE, MONTCLAIR, NJ 07042-4837
(973) 429-6260
Mailing address
137 ROMAINE AVE, MAYWOOD, NJ 07607-1948
(201) 845-5289
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25MA08170600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0232084
—
NJ
Enumeration date
07/15/2007
Last updated
08/03/2010
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