Provider Demographics
NPI:1427102771
Name:RICKERS & KULKARNI MEDICAL GROUP PA
Entity type:Organization
Organization Name:RICKERS & KULKARNI MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KULKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-564-5227
Mailing Address - Street 1:297 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5009
Mailing Address - Country:US
Mailing Address - Phone:973-564-5227
Mailing Address - Fax:973-564-5229
Practice Address - Street 1:116 MILLBURN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1943
Practice Address - Country:US
Practice Address - Phone:973-564-5227
Practice Address - Fax:973-564-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1883402Medicaid
NJ454929Medicare ID - Type UnspecifiedMEDICARE
NJ1883402Medicaid