Provider Demographics
NPI:1275038499
Name:SRINIVAS MADANE LLC
Entity Type:Organization
Organization Name:SRINIVAS MADANE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:JANARDHAN
Authorized Official - Last Name:MADANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-621-7778
Mailing Address - Street 1:33 RIDGELINE DR
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3376
Mailing Address - Country:US
Mailing Address - Phone:646-621-7778
Mailing Address - Fax:
Practice Address - Street 1:33 RIDGELINE DR
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-3376
Practice Address - Country:US
Practice Address - Phone:646-621-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07289400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty