Provider Demographics
NPI:1134626815
Name:HACKENSACK INFECTIOUS DISEASE ASSOCIATES, LLC
Entity type:Organization
Organization Name:HACKENSACK INFECTIOUS DISEASE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-464-3636
Mailing Address - Street 1:311 S IRVING ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5101
Mailing Address - Country:US
Mailing Address - Phone:908-464-3636
Mailing Address - Fax:908-464-6711
Practice Address - Street 1:311 S IRVING ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5101
Practice Address - Country:US
Practice Address - Phone:908-464-3636
Practice Address - Fax:908-464-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07276700207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty