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General NPI Number Information
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NPI Number | 1851324875
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES PROFESSIONALS LLC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 PROSPECT ST SUITE 115
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5020
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Country | US
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Telephone | 732-625-2465
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Fax |
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Provider Business Mailing Address
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Address Line | 101 PROSPECT ST SUITE 115
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDEEPA M UTPAT
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Credential |
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Telephone | 732-625-2465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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