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General NPI Number Information
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NPI Number | 1972655256
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL OB GYN & INFERTILITY CENTER OF IRVINGTON P A
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 566 NYE AVE
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City | IRVINGTON
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State | NJ
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Zip | 07111-3241
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Country | US
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Telephone | 973-399-9155
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Fax | 973-399-3936
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Provider Business Mailing Address
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Address Line | 566 NYE AVE
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City | IRVINGTON
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State | NJ
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Zip | 07111-3241
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Country | US
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Telephone | 973-399-9155
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Fax | 973-399-3936
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SURESH RADHAKISHIN THANI
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Credential | MD
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Telephone | 973-399-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MA37773
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License Number State | NJ
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