Provider Demographics
NPI:1124291893
Name:MEENAKSHI KUKREJA M D P A
Entity type:Organization
Organization Name:MEENAKSHI KUKREJA M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEENAKSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKREJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-755-0550
Mailing Address - Street 1:35-37 PROGRESS ST
Mailing Address - Street 2:SUITE B5
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1179
Mailing Address - Country:US
Mailing Address - Phone:908-755-0550
Mailing Address - Fax:908-755-3323
Practice Address - Street 1:35-37 PROGRESS ST
Practice Address - Street 2:SUITE B5
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1179
Practice Address - Country:US
Practice Address - Phone:908-755-0550
Practice Address - Fax:908-755-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03869900261QP2000X, 261QP2300X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ10327OtherUNIVERSITY HEALTH PLANS
NJ3245608Medicaid
NJ529210OtherUNITED HEALTH CARE
NJ23269OtherENGINEERS LOCAL 825
NJ18223OtherAMERIGROUP
NJ754356OtherMAIL HANDLERS
NJ40856OtherAETNA
NJ18223OtherAMERIGROUP
NJ529210OtherUNITED HEALTH CARE