| S. R. Id Group Professional Association | |
|
703 Main St Paterson NJ 07503-2621 | |
| (973) 754-2770 | |
| Not Available |
| Full Name | S. R. Id Group Professional Association |
|---|---|
| Speciality | Internal Medicine |
| Location | 703 Main St, Paterson, New Jersey |
| Authorized Official Name and Position | Yasmeen Sultana (OWNER) |
| Authorized Official Contact | 2015635651 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| S. R. Id Group Professional Association 11 Godwin Pl Clifton NJ 07013-3707 Ph: (201) 563-5651 | S. R. Id Group Professional Association 703 Main St Paterson NJ 07503-2621 Ph: (973) 754-2770 |
| NPI Number | 1306184155 |
|---|---|
| Provider Enumeration Date | 01/29/2013 |
| Last Update Date | 01/29/2013 |
| Medicare PECOS PAC ID | 5991940371 |
|---|---|
| Medicare Enrollment ID | O20130408000393 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306184155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 25MA09126400 (New Jersey) | Primary |
| Provider Name | Yasmeen Sultana |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1730442658 PECOS PAC ID: 5890930275 Enrollment ID: I20130408000412 |
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