Provider Demographics
NPI:1730413550
Name:SHIVENDRA PANDEY MD PC
Entity type:Organization
Organization Name:SHIVENDRA PANDEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-735-5455
Mailing Address - Street 1:19 FULLING MILL LN
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1278
Mailing Address - Country:US
Mailing Address - Phone:732-223-0008
Mailing Address - Fax:
Practice Address - Street 1:2640 HIGHWAY 70
Practice Address - Street 2:SUITE 101B BUILDING 12
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2609
Practice Address - Country:US
Practice Address - Phone:732-223-0008
Practice Address - Fax:732-223-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66691207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8177201Medicaid
NJH12008Medicare UPIN
NJ036265Medicare PIN