Provider Demographics
NPI:1740291095
Name:SEJAL MEDIC INC.
Entity type:Organization
Organization Name:SEJAL MEDIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH IN CHARGE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHREYAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-567-1881
Mailing Address - Street 1:48 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626
Mailing Address - Country:US
Mailing Address - Phone:201-567-2235
Mailing Address - Fax:201-567-1881
Practice Address - Street 1:48 UNION AVE
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626
Practice Address - Country:US
Practice Address - Phone:201-567-2235
Practice Address - Fax:201-567-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ280500631500333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4284003Medicaid
NJ4284003Medicaid