Organization
MAIN STREET MEDICAL PROVIDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANTHOSH CHAKILAM MD (OWNER)
(551) 223-7912
Entity
Organization
Contact information
Practice address
65 LEAH WAY, PARSIPPANY, NJ 07054-3448
(551) 223-7912
(646) 701-5598
Mailing address
65 LEAH WAY, PARSIPPANY, NJ 07054-3448
(551) 223-7912
(646) 701-5598
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA09915600
LICENSE
NJ
Enumeration date
12/14/2022
Last updated
12/14/2022
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