Organization
GARDEN STATE GERIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAVITHA SUBRAMANIAN M.D (PHYSICIAN)
(732) 491-1093
Entity
Organization
Contact information
Practice address
773 TEANECK ROAD, TEANECK, NJ 07666
(201) 530-5390
(201) 530-5391
Mailing address
53 HEATHER HILL RD, CRESSKILL, NJ 07626
(732) 491-1093
(201) 530-5391
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
25MA07857500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0153982
—
NJ
Enumeration date
04/30/2010
Last updated
05/27/2010
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