| Ironbound Newark Medical Pc | |
|
332 Ferry St Newark NJ 07105-3548 | |
| (973) 589-2171 | |
| (973) 589-6225 |
| Full Name | Ironbound Newark Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 332 Ferry St, Newark, New Jersey |
| Authorized Official Name and Position | Shan Sivendra (OWNER) |
| Authorized Official Contact | 2017046321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ironbound Newark Medical Pc 332 Ferry St Newark NJ 07105-3548 Ph: (973) 589-2171 | Ironbound Newark Medical Pc 332 Ferry St Newark NJ 07105-3548 Ph: (973) 589-2171 |
| NPI Number | 1598464117 |
|---|---|
| Provider Enumeration Date | 03/02/2023 |
| Last Update Date | 03/02/2023 |
| Medicare PECOS PAC ID | 5698130060 |
|---|---|
| Medicare Enrollment ID | O20230508002962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598464117 | NPI | - | NPPES |
| 8222801 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Shan Sivendra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538154307 PECOS PAC ID: 7012974678 Enrollment ID: I20041215000322 |
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