1285607739 NPI number — SANJIV K SHARMA M.D.

Table of content: SANJIV K SHARMA M.D. (NPI 1285607739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285607739 NPI number — SANJIV K SHARMA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARMA
Provider First Name:
SANJIV
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1285607739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MULE RD
Provider Second Line Business Mailing Address:
SUITE E-8
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08755-5043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-341-6070
Provider Business Mailing Address Fax Number:
732-341-6077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MULE RD
Provider Second Line Business Practice Location Address:
SUITE E-8
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755-5043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-341-6070
Provider Business Practice Location Address Fax Number:
732-341-6077
Provider Enumeration Date:
02/07/2006

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: 207R00000X , with the licence number:  25MA06957200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0300X , with the licence number: 25MA69572 , 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: 223755177 . This is a "TAX ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2376287 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8430501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110213348 . This is a "PALMETTO GBA/RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2187617 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 111281 . This is a "MEDICARE ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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