1346696499 NPI number — DR. SIDDHARTH ASHOK MAHURE MD, MBA

Table of content: DR. SIDDHARTH ASHOK MAHURE MD, MBA (NPI 1346696499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346696499 NPI number — DR. SIDDHARTH ASHOK MAHURE MD, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHURE
Provider First Name:
SIDDHARTH
Provider Middle Name:
ASHOK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MBA
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:
1346696499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 DIAMOND HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY HEIGHTS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07922-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-273-4300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SEYMOUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07042-3771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-302-6025
Provider Business Practice Location Address Fax Number:
862-357-8424
Provider Enumeration Date:
05/08/2016

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 25MA11450200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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