Provider Demographics
NPI:1386633881
Name:NATHAN, MEENA
Entity type:Individual
Prefix:DR
First Name:MEENA
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1416
Mailing Address - Country:US
Mailing Address - Phone:973-763-8542
Mailing Address - Fax:973-763-8562
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:L5, CHILDRENS HEART CENTER, NBIMC
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-4900
Practice Address - Fax:973-926-8206
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08144100208G00000X
MA154879208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2793166000OtherAMERIHEALTH INSURANCE COM
NJ0137837OtherGROUP HEALTH INCORPORATED
NJ0116017Medicaid
NJ270120087004OtherQUALCARE
NJ60027478OtherHORIZON NJ HEALTH
NJ7796322OtherAETNA, US HEALTHCARE
NJ317484OtherAMERIGROUP,AMERICAID
NJ6338708OtherCIGNA HEALTH CARE
NJ11087001OtherCOUNCIL OF AFFORDABLE QUA
NJ8430U1OtherWELLCHOICE, EMPIRE HEALTH
NJ0116017Medicaid