Provider Demographics
NPI:1740234939
Name:PENESETTI PRASAD MD ET AL
Entity Type:Organization
Organization Name:PENESETTI PRASAD MD ET AL
Other - Org Name:HOLMDEL CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-264-0210
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-0370
Mailing Address - Country:US
Mailing Address - Phone:732-264-0210
Mailing Address - Fax:732-888-9214
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-264-0210
Practice Address - Fax:732-888-9214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ628551Medicare ID - Type Unspecified