Active NPI
Indira Radhakrishnan, M.D.
- Anesthesiology Physician
- Newark, NJ
National Provider Identifier
1801964663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 25MA03660200
- Practice address
- 155 Jefferson St
Newark, NJ 07105-1706 - Phone
- (908) 490-0036
- Fax
- (908) 490-0067
- NPI assigned
- Dec 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 25MA03660200 | NJ | Primary |
| Anesthesiology Physician | 207L00000X | MA36602 | NJ |
Addresses
Primary practice location
155 Jefferson St
Newark, NJ 07105-1706
Mailing address
PO Box 1923
Bloomfield, NJ 07003-1923
Phone (908) 490-0036
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3915701 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA36602 | NJ | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Essex Ironbound Anesthesiologist, LLC | Anesthesiology | Past | Accepting new patients |
| Liberty Anesthesia, PC | Anesthesiology | Past | Accepting new patients |
| Essex Anesthesiolists PA | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Anesthesiology Physician
- Newark, NJ
- NPI 1083782890
Anesthesiology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193184000000",
"number": "1801964663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1923",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070031923",
"telephone_number": "908-490-0036",
"fax_number": "908-490-0067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 JEFFERSON ST",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071051706",
"telephone_number": "908-490-0036",
"fax_number": "908-490-0067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADHAKRISHNAN",
"first_name": "INDIRA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2007-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NJ",
"license": "25MA03660200",
"primary": true
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NJ",
"license": "MA36602",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3915701",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.