1063672376 NPI number — HERNEET K SAHANI MD

Table of content: HERNEET K SAHANI MD (NPI 1063672376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063672376 NPI number — HERNEET K SAHANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAHANI
Provider First Name:
HERNEET
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAHANI
Provider Other First Name:
HERNEET
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063672376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07039-0023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-497-2420
Provider Business Mailing Address Fax Number:
973-497-2421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
539 BLOOMFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07107-1385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-497-2420
Provider Business Practice Location Address Fax Number:
973-497-2421
Provider Enumeration Date:
06/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  MA 61803 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: MA061803 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7225806 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com