Provider Demographics
NPI:1093888059
Name:ANNE, SREELATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SREELATHA
Middle Name:
Last Name:ANNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 ROUTE 9 N
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3258
Mailing Address - Country:US
Mailing Address - Phone:732-625-3166
Mailing Address - Fax:
Practice Address - Street 1:4764 ROUTE 9 SOUTH
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731
Practice Address - Country:US
Practice Address - Phone:732-370-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08628100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0213993Medicaid
NJ0213993Medicaid