Provider Demographics
NPI:1710404884
Name:DISHA MEDICAL CARE CENTER LLC
Entity Type:Organization
Organization Name:DISHA MEDICAL CARE CENTER LLC
Other - Org Name:ISHA MEDICAL CARE CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-423-8292
Mailing Address - Street 1:7 SANTORA DR
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2313
Mailing Address - Country:US
Mailing Address - Phone:732-423-8292
Mailing Address - Fax:
Practice Address - Street 1:245 UNION AVE STE 2A
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3064
Practice Address - Country:US
Practice Address - Phone:732-423-8292
Practice Address - Fax:908-450-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00366127OtherRAILROAD