| Infectious Diseases Professionals Llc | |
|
101 Prospect St Suite 115 Lakewood NJ 08701-5020 | |
| (732) 625-2465 | |
| Not Available |
| Full Name | Infectious Diseases Professionals Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 101 Prospect St, Lakewood, New Jersey |
| Authorized Official Name and Position | Sandeepa M Utpat (OWNER) |
| Authorized Official Contact | 7326252465 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Diseases Professionals Llc 101 Prospect St Suite 115 Lakewood NJ 08701-5020 Ph: () - | Infectious Diseases Professionals Llc 101 Prospect St Suite 115 Lakewood NJ 08701-5020 Ph: (732) 625-2465 |
| NPI Number | 1851324875 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1355341546 |
|---|---|
| Medicare Enrollment ID | O20070112000068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851324875 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Sandeepa M Utpat |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1205864899 PECOS PAC ID: 4284685249 Enrollment ID: I20070105000088 |
| Provider Name | Travis Lamont Hendricks |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1487911012 PECOS PAC ID: 5294044699 Enrollment ID: I20170906002982 |
| Provider Name | Richard Valderas Penalosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679046601 PECOS PAC ID: 6608114731 Enrollment ID: I20190313002720 |
| Provider Name | Venus S Balaoing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285292060 PECOS PAC ID: 3072849504 Enrollment ID: I20190722002945 |
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