Ironbound Newark Medical PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

IRONBOUND NEWARK MEDICAL PC

Practice address

332 Ferry St
Newark, NJ 07105-3548

Phone

(973) 589-2171

Fax

(973) 589-6225

NPI assigned

Mar 2, 2023

Last updated

Mar 2, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shan Sivendra, MD

Title

Owner

Phone

(201) 704-6321

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1598464117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 FERRY ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071053548",
            "telephone_number": "973-589-2171",
            "fax_number": "973-589-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 FERRY ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071053548",
            "telephone_number": "973-589-2171",
            "fax_number": "973-589-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRONBOUND NEWARK MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-02",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "SIVENDRA",
        "authorized_official_first_name": "SHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-704-6321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8222801",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Newark, NJ
• Providers in Newark, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.