Provider Demographics
NPI:1962538298
Name:SRIDHAR S.NAMBI., MD., P.C.
Entity type:Organization
Organization Name:SRIDHAR S.NAMBI., MD., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:SRINIVASAN
Authorized Official - Last Name:NAMBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-535-8870
Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5604
Mailing Address - Country:US
Mailing Address - Phone:973-535-8870
Mailing Address - Fax:973-535-8818
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE # 201
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-535-8870
Practice Address - Fax:973-535-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06771600207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094527Medicare ID - Type Unspecified