Provider Demographics
NPI:1184892176
Name:SSS PHYSICAL MEDICINE & REHABILITATION SVCS, LLC
Entity type:Organization
Organization Name:SSS PHYSICAL MEDICINE & REHABILITATION SVCS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VANI
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDAVOLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-683-3828
Mailing Address - Street 1:9 JUSTICE CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-9545
Mailing Address - Country:US
Mailing Address - Phone:609-683-3828
Mailing Address - Fax:609-964-1666
Practice Address - Street 1:253 WITHERSPOON STREET
Practice Address - Street 2:UNIVERSITY MEDICAL CENTER AT PRINCETON
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3211
Practice Address - Country:US
Practice Address - Phone:609-497-3022
Practice Address - Fax:609-964-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05450300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7227604Medicaid
NJ7227604Medicaid