NPI 1619403862

Garden State I D LLC

Organisation Prevention Professional Edison, NJ

Practice location

Address: 36 Huntington Rd, Edison, NJ 08820-3108
Phone: (646) 660-5696
Mailing address: 36 Huntington Road, Ed, NJ 08820

Authorised official

Name: Aruna Sree
Title: M.D.
Phone: (908) 249-9512

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 25MA08871700 (NJ)

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Registry record

NPI: 1619403862
Entity type: Organization
NPI issued: 10 May 2017
Record last updated: 10 May 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.