1538369418 NPI number — DR. SREENIVASRAO AMARA M.D.

Table of content: DR. SREENIVASRAO AMARA M.D. (NPI 1538369418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538369418 NPI number — DR. SREENIVASRAO AMARA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMARA
Provider First Name:
SREENIVASRAO
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1538369418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
B2 CORNWALL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-3352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-257-4008
Provider Business Mailing Address Fax Number:
732-257-1958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
B2 CORNWALL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-257-4008
Provider Business Practice Location Address Fax Number:
732-257-1958
Provider Enumeration Date:
07/19/2007

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: 207K00000X , with the licence number:  236569 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: 25MA08217500 , 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)

  • Identifier: 6N6381 . This is a "EMPIRE BC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0232955 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01004808200 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1293197 . This is a "G.H.I." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2050340 . This is a "COVENTRY HEALTH/FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P4061407 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01307948 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1522135 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1538269418 . This is a "U.S.FAMILY HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6060012 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9376056 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60075061 . This is a "HORIZON N.J. HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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