Provider Demographics
NPI:1962790162
Name:NORTHEASTERN MEDICAL
Entity type:Organization
Organization Name:NORTHEASTERN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SETHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-887-3440
Mailing Address - Street 1:262 ROUTE 10 W
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1322
Mailing Address - Country:US
Mailing Address - Phone:888-877-4310
Mailing Address - Fax:877-693-4551
Practice Address - Street 1:262 ROUTE 10 W
Practice Address - Street 2:SUITE B
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1322
Practice Address - Country:US
Practice Address - Phone:888-877-4310
Practice Address - Fax:877-693-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies