Provider Demographics
NPI:1538359633
Name:THAKKER, PRIYA (MD)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:THAKKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRIYA
Other - Middle Name:SAMBANDAN
Other - Last Name:THAKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:719 N BEERS ST
Mailing Address - Street 2:UNIT 2G
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1522
Mailing Address - Country:US
Mailing Address - Phone:732-739-3223
Mailing Address - Fax:
Practice Address - Street 1:719 N BEERS ST
Practice Address - Street 2:UNIT 2G
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1522
Practice Address - Country:US
Practice Address - Phone:732-739-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231750207N00000X
NJ25MA08829200207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology