Organization
SHAN NAGENDRA,M.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAN NAGENDRA M.D. (OWNER)
(201) 823-3390
Entity
Organization
Contact information
Practice address
654 AVENUE C, BAYONNE, NJ 07002-3899
(201) 823-3390
(201) 823-4420
Mailing address
654 AVENUE C, BAYONNE, NJ 07002-3899
(201) 823-3390
(201) 823-4420
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA30013
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3195503
—
NJ
Enumeration date
12/05/2007
Last updated
12/05/2007
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