1740234939 NPI number — PENESETTI PRASAD MD ET AL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740234939 NPI number — PENESETTI PRASAD MD ET AL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENESETTI PRASAD MD ET AL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOLMDEL CARDIOLOGY ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740234939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLMDEL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07733-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-264-0210
Provider Business Mailing Address Fax Number:
732-888-9214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 N BEERS ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
HOLMDEL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07733-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-264-0210
Provider Business Practice Location Address Fax Number:
732-888-9214
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
NIRANJAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
732-264-0210

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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