Provider Demographics
NPI:1447710645
Name:REVURI, NIKIL R (MD)
Entity type:Individual
Prefix:DR
First Name:NIKIL
Middle Name:R
Last Name:REVURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:2 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1663
Practice Address - Country:US
Practice Address - Phone:973-437-2630
Practice Address - Fax:862-660-6695
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-09-18
Deactivation Date:2019-03-24
Deactivation Code:
Reactivation Date:2019-05-08
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12148200207RR0500X
MA280414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine