Provider Demographics
NPI:1134462245
Name:HIRAK GUHA MDPA
Entity Type:Organization
Organization Name:HIRAK GUHA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HIRAK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-548-0122
Mailing Address - Street 1:44 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3978
Mailing Address - Country:US
Mailing Address - Phone:732-548-0122
Mailing Address - Fax:732-548-2346
Practice Address - Street 1:44 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3978
Practice Address - Country:US
Practice Address - Phone:732-548-0122
Practice Address - Fax:732-548-2346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIRAK GUHA MDPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA030942002086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0152803Medicaid
NJGU582077Medicare PIN
NJC59651Medicare UPIN