=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609932532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAI MEDICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 03/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 252 WASHINGTON AVE
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-450-9600
-----------------------------------------------------
Fax | 973-450-4054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 362
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109-0362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-450-9600
-----------------------------------------------------
Fax | 973-450-4054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SRINIVASA ESWARAPU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 973-450-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MA68009
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------