Healthcare Provider Details

I. General information

NPI: 1457377079
Provider Name (Legal Business Name): RASHMI SANDEEP MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 ROUTE 70
BRICK NJ
08724-2670
US

IV. Provider business mailing address

1301 ROUTE 70
BRICK NJ
08724-2670
US

V. Phone/Fax

Practice location:
  • Phone: 732-892-8700
  • Fax: 732-892-6689
Mailing address:
  • Phone: 732-892-8700
  • Fax: 732-892-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07147500
License Number StateNJ

VIII. Authorized Official

Name: DR. RASHMI SANDEEP
Title or Position: PRESIDENT
Credential: MD
Phone: 732-892-8700