Healthcare Provider Details

I. General information

NPI: 1063652642
Provider Name (Legal Business Name): SAI LAKSHMI RAMANUJAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 MAIN ST
TOMS RIVER NJ
08753-7418
US

IV. Provider business mailing address

106 ROBBINSVILLE ALLENTOWN RD
ROBBINSVILLE NJ
08691-1627
US

V. Phone/Fax

Practice location:
  • Phone: 732-240-3760
  • Fax: 732-240-3865
Mailing address:
  • Phone: 732-768-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number25MA09150200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: