Provider Demographics
NPI:1053388439
Name:NAMBI, SRIDHAR SRINIVASAN (MD)
Entity type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:SRINIVASAN
Last Name:NAMBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-535-8870
Mailing Address - Fax:973-535-8818
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-535-8870
Practice Address - Fax:973-535-8818
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06771600207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA06771600OtherLICENSE
NJP00094173OtherRAILROAD MEDICARE PIN
NJ65-1262400OtherTAXID
NJ04-3694523OtherTAX ID
NJ25MA06771600OtherLICENSE
NJ04-3694523OtherTAX ID