Provider Demographics
NPI:1164761953
Name:SAUDE MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SAUDE MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURO
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:973-535-5279
Mailing Address - Street 1:28 WILSON TER
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2941
Mailing Address - Country:US
Mailing Address - Phone:973-535-5279
Mailing Address - Fax:
Practice Address - Street 1:28 WILSON TER
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2941
Practice Address - Country:US
Practice Address - Phone:973-535-5279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00133200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care