Provider Demographics
NPI:1427064203
Name:AMARNATH AVANCHA PA
Entity type:Organization
Organization Name:AMARNATH AVANCHA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARNATH
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACC
Authorized Official - Phone:973-777-1132
Mailing Address - Street 1:124 GREGORY AVE
Mailing Address - Street 2:UNIT 102
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4856
Mailing Address - Country:US
Mailing Address - Phone:973-777-1132
Mailing Address - Fax:973-458-9850
Practice Address - Street 1:124 GREGORY AVE.
Practice Address - Street 2:UNIT 102
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4856
Practice Address - Country:US
Practice Address - Phone:973-777-1132
Practice Address - Fax:973-458-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA058773207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7462409Medicaid
NJG48463Medicare UPIN
NJ7462409Medicaid