Provider Demographics
NPI:1275672511
Name:HERNEET SAHANI MD PA
Entity Type:Organization
Organization Name:HERNEET SAHANI MD PA
Other - Org Name:HERNEET K SAHANI MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-497-2420
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0023
Mailing Address - Country:US
Mailing Address - Phone:973-497-2420
Mailing Address - Fax:973-912-0024
Practice Address - Street 1:539 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107
Practice Address - Country:US
Practice Address - Phone:973-497-2420
Practice Address - Fax:973-497-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06180300207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7225806Medicaid
NJ722637Medicare PIN
NJ7225806Medicaid