MEDICARE: MRS. SARUP GIRDHARI NARIANI M.D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	149270	NY
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	149270	NY
3	207RA0401X	Addiction Medicine (Internal Medicine) Physician	25MA03980800	NJ

General Provider Information

NPI Number	:	1417114307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARUP GIRDHARI NARIANI M.D,

Provider Business Mailing Address
First Line	:	777 SEAVIEW AVE
Second Line	:	SUOUTH BEACH ADDICTION TREATMENT CENTER, BLDG.1,2ND FL
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3409
Country	:	US
Telephone Number	:	718-667-2805
Fax Number	:	718-667-2773

Provider Business Practice Location Address
First Line	:	777 SEAVIEW AVE
Second Line	:	SUOUTH BEACH ADDICTION TREATMENT CENTER, BLDG.1,2ND FL
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3409
Country	:	US
Telephone Number	:	718-667-2805
Fax Number	:	718-667-2773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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