Provider Demographics
NPI:1487913026
Name:THAKUR, SHIVANI (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:
Last Name:THAKUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-4001
Mailing Address - Country:US
Mailing Address - Phone:908-735-2594
Mailing Address - Fax:908-735-8526
Practice Address - Street 1:61 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-4001
Practice Address - Country:US
Practice Address - Phone:908-735-2594
Practice Address - Fax:908-735-8526
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10000700207Q00000X
KY47241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0572462Medicaid
KY7100311190Medicaid