NPIMap

Organization Active NPI

Garden State Geriatrics LLC

  • Primary Care Clinic/Center
  • Teaneck, NJ
National Provider Identifier
1861719718
Registry record updated May 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
25MA07857500 Issued in NJ
Legal business name
GARDEN STATE GERIATRICS LLC
Practice address
773 Teaneck Road
Teaneck, NJ 07666
Phone
(201) 530-5390
Fax
(201) 530-5391
NPI assigned
Apr 30, 2010
Last updated
May 27, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2010

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

Authorized official

Name
Dr. Kavitha Subramanian, M.D
Title
Physician
Phone
(732) 491-1093

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 25MA07857500 NJ Primary

Addresses

Primary practice location

773 Teaneck Road
Teaneck, NJ 07666

Mailing address

53 Heather Hill Rd
Cresskill, NJ 07626
Phone (732) 491-1093

Other identifiers 1

IdentifierTypeStateIssuer
0153982MedicaidNJ

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1272585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274918400000",
    "number": "1861719718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 HEATHER HILL RD",
            "city": "CRESSKILL",
            "state": "NJ",
            "postal_code": "07626",
            "telephone_number": "732-491-1093",
            "fax_number": "201-530-5391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "773 TEANECK ROAD",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "07666",
            "telephone_number": "201-530-5390",
            "fax_number": "201-530-5391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDEN STATE GERIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-30",
        "last_updated": "2010-05-27",
        "status": "A",
        "authorized_official_last_name": "SUBRAMANIAN",
        "authorized_official_first_name": "KAVITHA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "732-491-1093",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "25MA07857500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0153982",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2010; 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.