Provider Demographics
NPI:1750497772
Name:APOLLO HEALTH CENTER LLC
Entity Type:Organization
Organization Name:APOLLO HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOBA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVICHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-284-2307
Mailing Address - Street 1:7 CLARENDON CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 MIDDLE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1957
Practice Address - Country:US
Practice Address - Phone:646-284-2307
Practice Address - Fax:732-946-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty