Provider Demographics
NPI:1316907983
Name:TAKLA, SARWAT S (MD)
Entity type:Individual
Prefix:MR
First Name:SARWAT
Middle Name:S
Last Name:TAKLA
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:PO BOX 1550
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1550
Mailing Address - Country:US
Mailing Address - Phone:732-281-8580
Mailing Address - Fax:732-551-2075
Practice Address - Street 1:1163 ROUTE 37 W STE C1
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4975
Practice Address - Country:US
Practice Address - Phone:732-281-8580
Practice Address - Fax:732-551-2075
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06588900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7402601Medicaid
NJ960063Medicare ID - Type Unspecified
NJ7402601Medicaid