Provider Demographics
NPI:1043228588
Name:ADMANI, IRFAN
Entity Type:Individual
Prefix:
First Name:IRFAN
Middle Name:
Last Name:ADMANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020
Mailing Address - Country:US
Mailing Address - Phone:201-941-8100
Mailing Address - Fax:201-941-2899
Practice Address - Street 1:103 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020
Practice Address - Country:US
Practice Address - Phone:201-941-8100
Practice Address - Fax:201-941-2899
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07010400207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3K4611OtherHEALTHNET
NY02810057Medicaid
NJ2771801000OtherAMERIHEALTH#
NJ7616451OtherAETNA PPO #
NJ719P01OtherEMPIRE BCBS EDGEWATER#
NJ789P01OtherEMPIRE BCBS# SECAUCUS
NJP00336977OtherRAILROAD MEDICARE ID#
NJ1369767OtherAETNA HMO #
NJ8440905Medicaid
NY02810057Medicaid
NJ044906CN5Medicare PIN