| Main Street Medical Providers Llc | |
|
65 Leah Way Parsippany NJ 07054-3448 | |
| (551) 223-7912 | |
| (646) 701-5598 |
| Full Name | Main Street Medical Providers Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 65 Leah Way, Parsippany, New Jersey |
| Authorized Official Name and Position | Santhosh Chakilam (OWNER) |
| Authorized Official Contact | 5512237912 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Medical Providers Llc 65 Leah Way Parsippany NJ 07054-3448 Ph: (551) 223-7912 | Main Street Medical Providers Llc 65 Leah Way Parsippany NJ 07054-3448 Ph: (551) 223-7912 |
| NPI Number | 1790497444 |
|---|---|
| Provider Enumeration Date | 12/14/2022 |
| Last Update Date | 12/14/2022 |
| Medicare PECOS PAC ID | 3971973702 |
|---|---|
| Medicare Enrollment ID | O20230112000046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790497444 | NPI | - | NPPES |
| 25MA09915600 | Other | NJ | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Santhosh Chakilam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184988628 PECOS PAC ID: 1951690965 Enrollment ID: I20161006000335 |
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