Provider Demographics
NPI:1730326133
Name:RIAR, SANDEEP S (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:S
Last Name:RIAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-3533
Mailing Address - Country:US
Mailing Address - Phone:732-541-2141
Mailing Address - Fax:732-541-1038
Practice Address - Street 1:237 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-3533
Practice Address - Country:US
Practice Address - Phone:732-541-2141
Practice Address - Fax:732-541-1038
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08500100207R00000X
PAMD447229207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0204358Medicaid
NJ0308692Medicaid
NJ163078UWWMedicare PIN
NJ0308692Medicaid
NJ163078S6SMedicare PIN