Provider Demographics
NPI:1306184155
Name:S. R. ID GROUP PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:S. R. ID GROUP PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-563-5651
Mailing Address - Street 1:11 GODWIN PL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3707
Mailing Address - Country:US
Mailing Address - Phone:201-563-5651
Mailing Address - Fax:
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09126400207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty