Provider Demographics
NPI:1114140365
Name:SRINIVASA R. MOVVA, M.D.PC
Entity Type:Organization
Organization Name:SRINIVASA R. MOVVA, M.D.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-291-3430
Mailing Address - Street 1:37 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1327
Mailing Address - Country:US
Mailing Address - Phone:732-291-3430
Mailing Address - Fax:732-291-5659
Practice Address - Street 1:37 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1327
Practice Address - Country:US
Practice Address - Phone:732-291-3430
Practice Address - Fax:732-291-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06591900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7704305Medicaid
NJ085988Medicare ID - Type Unspecified
NJG79633Medicare UPIN