Provider Demographics
NPI:1003184078
Name:SHARAN RAMPAL MDPA
Entity Type:Organization
Organization Name:SHARAN RAMPAL MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-455-6711
Mailing Address - Street 1:60 LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-4326
Mailing Address - Country:US
Mailing Address - Phone:856-455-6711
Mailing Address - Fax:856-455-1979
Practice Address - Street 1:60 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-4326
Practice Address - Country:US
Practice Address - Phone:856-455-6711
Practice Address - Fax:856-455-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA037648002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0578401Medicaid
NJ0578401Medicaid