Provider Demographics
NPI:1427366350
Name:POLSANI, SRUJANA (MD)
Entity Type:Individual
Prefix:
First Name:SRUJANA
Middle Name:
Last Name:POLSANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GRAND ST, APT# 3312
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543
Mailing Address - Country:US
Mailing Address - Phone:443-283-7601
Mailing Address - Fax:
Practice Address - Street 1:88 PRINCETON HIGHTSTOWN RD # R
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1100
Practice Address - Country:US
Practice Address - Phone:609-750-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09305400207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty