Provider Demographics
NPI:1861741019
Name:NUTHAKKI, VIMALA DEVI (MD)
Entity type:Individual
Prefix:DR
First Name:VIMALA
Middle Name:DEVI
Last Name:NUTHAKKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:1555 RUTH RD STE 5
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4074
Practice Address - Country:US
Practice Address - Phone:732-398-3939
Practice Address - Fax:732-398-0909
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09072900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology