Healthcare Provider Details

I. General information

NPI: 1396753166
Provider Name (Legal Business Name): CENTER FOR INFECTIOUS DISEASES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 507
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE SUITE 507
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-4088
  • Fax: 201-489-8930
Mailing address:
  • Phone: 201-487-4088
  • Fax: 201-489-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA09331500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier016954400
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name: RANI SEBTI
Title or Position: PRESIDENT
Credential: MD
Phone: 201-487-4088