Provider Demographics
NPI:1285794628
Name:SANTHOSH K. CHEELA
Entity type:Organization
Organization Name:SANTHOSH K. CHEELA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTHOSH
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHEELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-525-0200
Mailing Address - Street 1:200 PERRINE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2842
Mailing Address - Country:US
Mailing Address - Phone:732-525-0200
Mailing Address - Fax:732-525-0275
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-525-0200
Practice Address - Fax:732-525-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71713207R00000X
NJMA53855207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty