Provider Demographics
NPI:1376611939
Name:SADDLE RIVER MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:SADDLE RIVER MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-825-3933
Mailing Address - Street 1:82 E ALLENDALE RD
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-3057
Mailing Address - Country:US
Mailing Address - Phone:201-825-3933
Mailing Address - Fax:201-236-1460
Practice Address - Street 1:82 E ALLENDALE RD
Practice Address - Street 2:SUITE 3-A
Practice Address - City:SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-3057
Practice Address - Country:US
Practice Address - Phone:201-825-3933
Practice Address - Fax:201-236-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 40304261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56281Medicare UPIN
NJ023794Medicare ID - Type UnspecifiedMEDICARE NUMBER