Provider Demographics
NPI:1124594809
Name:SRI MEDICAL CENTER, INC
Entity type:Organization
Organization Name:SRI MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KARRY MOHANRAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-829-8476
Mailing Address - Street 1:PO BOX 4577
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-4577
Mailing Address - Country:US
Mailing Address - Phone:973-275-0570
Mailing Address - Fax:973-900-8453
Practice Address - Street 1:2115 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3724
Practice Address - Country:US
Practice Address - Phone:973-275-0570
Practice Address - Fax:973-900-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0155641Medicaid