Provider Demographics
NPI:1033193628
Name:NAYYAR, SANJEEV (MD)
Entity Type:Individual
Prefix:MR
First Name:SANJEEV
Middle Name:
Last Name:NAYYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:WICKATUNK
Mailing Address - State:NJ
Mailing Address - Zip Code:07765-0209
Mailing Address - Country:US
Mailing Address - Phone:732-525-0600
Mailing Address - Fax:732-525-9777
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE 231
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-525-0600
Practice Address - Fax:732-525-9777
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA59602207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ420072Medicare ID - Type Unspecified
F68827Medicare UPIN