1528176203 NPI number — RITUDEEP BASRA

Table of content: RITUDEEP BASRA (NPI 1528176203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528176203 NPI number — RITUDEEP BASRA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASRA
Provider First Name:
RITUDEEP
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASRA
Provider Other First Name:
RITU
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528176203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 STEPHENVILLE PKWY
Provider Second Line Business Mailing Address:
STE 2C
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08820-3061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 STEPHENVILLE PKWY
Provider Second Line Business Practice Location Address:
STE 2C
Provider Business Practice Location Address City Name:
EDISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08820-3061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-293-8636
Provider Business Practice Location Address Fax Number:
908-552-3558
Provider Enumeration Date:
08/25/2006

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: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 40QA00722300 . This is a "LICENSE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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