Provider Demographics
NPI:1376531426
Name:GARDEN STATE MEDICAL MULTI SPECIALTY GROUP PA
Entity Type:Organization
Organization Name:GARDEN STATE MEDICAL MULTI SPECIALTY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-396-9500
Mailing Address - Street 1:53 WESTFIELD AVE # 59
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-3262
Mailing Address - Country:US
Mailing Address - Phone:732-396-9500
Mailing Address - Fax:732-382-1377
Practice Address - Street 1:53 WESTFIELD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-3262
Practice Address - Country:US
Practice Address - Phone:732-396-9500
Practice Address - Fax:732-382-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03620200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1189107Medicaid
NJ673155Medicare PIN
NJ1189107Medicaid