Provider Demographics
NPI:1174729842
Name:THE ENDOCRINE DOCTOR INC.
Entity type:Organization
Organization Name:THE ENDOCRINE DOCTOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONOO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-992-1118
Mailing Address - Street 1:315 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4896
Mailing Address - Country:US
Mailing Address - Phone:973-992-1118
Mailing Address - Fax:973-992-3050
Practice Address - Street 1:315 E NORTHFIELD RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4896
Practice Address - Country:US
Practice Address - Phone:973-992-1118
Practice Address - Fax:973-992-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068064207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090182OtherMEDICARE PTAN
NJDD8573OtherMEDICARE RAILROAD
NJDD8573OtherMEDICARE RAILROAD