Provider Demographics
NPI:1811211964
Name:ADVANCED ENDOCRINOLOGY,LLC
Entity Type:Organization
Organization Name:ADVANCED ENDOCRINOLOGY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-226-9050
Mailing Address - Street 1:310 WOODSTOWN RD FL 4
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2064
Mailing Address - Country:US
Mailing Address - Phone:856-226-9050
Mailing Address - Fax:
Practice Address - Street 1:310 WOODSTOWN RD FL 4
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2064
Practice Address - Country:US
Practice Address - Phone:856-226-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06485600207R00000X
207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059676Medicaid
NJ0059676Medicaid