Doctor Name: | LOGITHYA SUBENDRA-KONINI |
NPI Number: | 1447520200 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | |
Business Practice Address: | 110 Rehill Ave Somerville, NJ - 088762519 |
Business Phone Number: | 9086852900 |
Business Fax Number: | 9087043764 |
Mailing Address: | 7373 West Ln, STOCKTON |
State: | CA |
Postal Code: | 952103377 |
Phone Number: | 2094762000 |
Fax Number: | |
NPI Enumeration Date: | 01/10/2012 |
NPI Last Update Date: | 04/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |