Provider Demographics
NPI:1891909941
Name:SIPARADIGM LLC
Entity Type:Organization
Organization Name:SIPARADIGM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMICOSANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-395-9124
Mailing Address - Street 1:25 RIVERSIDE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9391
Mailing Address - Country:US
Mailing Address - Phone:201-599-9044
Mailing Address - Fax:201-599-9066
Practice Address - Street 1:25 RIVERSIDE DR STE 2
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9391
Practice Address - Country:US
Practice Address - Phone:201-599-9044
Practice Address - Fax:201-599-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00007503291U00000X
NJ25MA05880800291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00213695OtherRAILROAD
SI0S64U020OtherEMPIRE BCBS
000000039833OtherBOSTON MEDICAL CENTER
269580OtherAMERIGROUP
250588080OtherHIPUSA
7262661OtherAETNA
NJ0066222Medicaid
427253OtherTUFTS HEALTH PLAN
60013223OtherHORIZON NJ HEALTH
9759537OtherGHI
A3638184OtherOXFORD HEALTH PLAN
J35526OtherHEALTHNET
250588080OtherHIPUSA
P00213695OtherRAILROAD
269580OtherAMERIGROUP
=========43614A001OtherTRICARE