Provider Demographics
NPI:1215117346
Name:MAYURI MEDICAL CENTER LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:MAYURI MEDICAL CENTER LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHALAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SESHADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-431-0003
Mailing Address - Street 1:603A OMNI DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4538
Mailing Address - Country:US
Mailing Address - Phone:908-431-0003
Mailing Address - Fax:908-431-0009
Practice Address - Street 1:603A OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4538
Practice Address - Country:US
Practice Address - Phone:908-431-0003
Practice Address - Fax:908-431-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07629200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0109495Medicaid
NJ102810Medicare PIN
NJ0109495Medicaid