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General NPI Number Information
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NPI Number | 1710404884
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Entity Type | Organization
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Legal Business Name | DISHA MEDICAL CARE CENTER LLC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 245 UNION AVE STE 2A
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-3064
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Country | US
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Telephone | 732-423-8292
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Fax | 908-450-7737
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Provider Business Mailing Address
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Address Line | 7 SANTORA DR
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City | RARITAN
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State | NJ
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Zip | 08869-2313
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Country | US
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Telephone | 732-423-8292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEETA YALAMANCHI
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Credential | MD
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Telephone | 732-423-8292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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