Provider Demographics
NPI:1285607739
Name:SHARMA, SANJIV K (MD)
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:K
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MULE RD
Mailing Address - Street 2:SUITE E-8
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5043
Mailing Address - Country:US
Mailing Address - Phone:732-341-6070
Mailing Address - Fax:732-341-6077
Practice Address - Street 1:9 MULE RD
Practice Address - Street 2:SUITE E-8
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5043
Practice Address - Country:US
Practice Address - Phone:732-341-6070
Practice Address - Fax:732-341-6077
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06957200207R00000X
NJ25MA69572207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223755177OtherTAX ID
NJ2376287OtherAETNA
NJ8430501Medicaid
NJ110213348OtherPALMETTO GBA/RR MEDICARE
NJP2187617OtherOXFORD
NJ111281OtherMEDICARE ID
NJP2187617OtherOXFORD
NJ111281OtherMEDICARE ID