Provider Demographics
NPI:1609932532
Name:SAI MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SAI MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESWARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-450-9600
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-0362
Mailing Address - Country:US
Mailing Address - Phone:973-450-9600
Mailing Address - Fax:973-450-4054
Practice Address - Street 1:252 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3155
Practice Address - Country:US
Practice Address - Phone:973-450-9600
Practice Address - Fax:973-450-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119683Medicare PIN