Basic Information
| Provider Information | |||||||||
| NPI: | 1578558748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SARVAIYA | ||||||||
| FirstName: | RAMESH | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. ANESTHESIOLOGIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080961617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568450100 | ||||||||
| FaxNumber: | 8568487023 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 W RED BANK AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080961630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568484464 | ||||||||
| FaxNumber: | 8568487023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | NJ | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 25MA07343200 | 01 | NJ | MEDICAL LICENSE | OTHER | 0026701 | 05 | NJ | MEDICAID | D08111300 | 01 | NJ | CDS | OTHER | BS7597860 | 01 | NJ | DEA | OTHER |