Provider Demographics
NPI:1104804400
Name:PANDYA, MADHUKAR (MD)
Entity type:Individual
Prefix:DR
First Name:MADHUKAR
Middle Name:
Last Name:PANDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LINCOLN ST
Mailing Address - Street 2:MADHUKAR PANDYA MD
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2933
Mailing Address - Country:US
Mailing Address - Phone:201-963-5009
Mailing Address - Fax:201-659-5350
Practice Address - Street 1:20 LINCOLN ST
Practice Address - Street 2:MADHUKAR PANDYA MD
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2933
Practice Address - Country:US
Practice Address - Phone:201-963-5009
Practice Address - Fax:201-659-5350
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03978000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1884409Medicaid
C55660Medicare UPIN
NJ1884409Medicaid