Provider Demographics
NPI:1528172111
Name:UNIVERSITY GERIATRICS & INTERNAL MEDICINE ASSOCIATES,LLC
Entity type:Organization
Organization Name:UNIVERSITY GERIATRICS & INTERNAL MEDICINE ASSOCIATES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHPANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-246-2313
Mailing Address - Street 1:1553 STATE ROUTE 27
Mailing Address - Street 2:SUITE # 3300
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3980
Mailing Address - Country:US
Mailing Address - Phone:732-418-0589
Mailing Address - Fax:732-418-9428
Practice Address - Street 1:1553 STATE ROUTE 27
Practice Address - Street 2:SUITE # 3300
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3980
Practice Address - Country:US
Practice Address - Phone:732-418-0589
Practice Address - Fax:732-418-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5775400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6971903Medicaid
NJ043864Medicare PIN
NJF27244Medicare UPIN