Provider Demographics
NPI:1316269145
Name:HATTANGADI, DEEPALI KISHORE (MS)
Entity type:Individual
Prefix:MS
First Name:DEEPALI
Middle Name:KISHORE
Last Name:HATTANGADI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 COBBLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-1948
Mailing Address - Country:US
Mailing Address - Phone:609-977-2510
Mailing Address - Fax:
Practice Address - Street 1:120 FIELDCREST AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3656
Practice Address - Country:US
Practice Address - Phone:732-346-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03145100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist