Organization
SSA TELE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRISH AMRUTIA MD (ORGANIZER)
(516) 665-1883
Entity
Organization
Contact information
Practice address
2264 MOONDANCE LN, MARIETTA, GA 30062-2890
(856) 296-0946
Mailing address
2264 MOONDANCE LN, MARIETTA, GA 30062-2890
(856) 296-0946
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
05/05/2021
Last updated
08/18/2021
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