Provider Demographics
NPI:1043828577
Name:SIDDHIVINAYAK INC.
Entity Type:Organization
Organization Name:SIDDHIVINAYAK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RASIK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGRECHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-992-1951
Mailing Address - Street 1:23 CANOE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-6121
Mailing Address - Country:US
Mailing Address - Phone:973-992-1951
Mailing Address - Fax:973-992-8190
Practice Address - Street 1:90 BERGEN ST # 1600
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-1960
Practice Address - Fax:973-972-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8172501Medicaid