1568425601 NPI number — DR. CHINTANA SANG-URAI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568425601 NPI number — DR. CHINTANA SANG-URAI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SANG-URAI

Provider First Name:

CHINTANA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1568425601

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/20/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

66 W GILBERT ST

Provider Second Line Business Mailing Address:

2ND FLOOR

Provider Business Mailing Address City Name:

TINTON FALLS

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07701-4947

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

732-212-0060

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

530 NEW BRUNSWICK AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PERTH AMBOY

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08861-3674

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

732-442-3700

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207P00000X , with the licence number:  25MA03088800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207P00000X , with the licence number: MD035501L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 85808 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2516347 . This is a "GHI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P00130325 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2420201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 818764 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 000926778 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 001840040 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 02729633 . This is a "NEW YORK MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P00105057 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".