Organization
IRONBOUND NEWARK MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAN SIVENDRA MD (OWNER)
(201) 704-6321
Entity
Organization
Contact information
Practice address
332 FERRY ST, NEWARK, NJ 07105-3548
(973) 589-2171
(973) 589-6225
Mailing address
332 FERRY ST, NEWARK, NJ 07105-3548
(973) 589-2171
(973) 589-6225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8222801
—
NJ
Enumeration date
03/02/2023
Last updated
03/02/2023
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