Provider Demographics
NPI:1386706778
Name:ACHARI, PREMA (MARD)
Entity type:Individual
Prefix:MRS
First Name:PREMA
Middle Name:
Last Name:ACHARI
Suffix:
Gender:F
Credentials:MARD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 INDIAN RUN
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07946-1602
Mailing Address - Country:US
Mailing Address - Phone:908-580-1856
Mailing Address - Fax:908-753-3640
Practice Address - Street 1:52 INDIAN RUN
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07946-1602
Practice Address - Country:US
Practice Address - Phone:908-580-1856
Practice Address - Fax:908-753-3640
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL478940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056432Medicare ID - Type Unspecified