| Srisai Gowda Md Llc | |
|
2106 New Road D-8 Linwood NJ 08221 | |
| (609) 927-1030 | |
| (609) 927-9985 |
| Full Name | Srisai Gowda Md Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2106 New Road, Linwood, New Jersey |
| Authorized Official Name and Position | Srisai Gowda (OWNER) |
| Authorized Official Contact | 6099271030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Srisai Gowda Md Llc 2106 New Road D-8 Linwood NJ 08221 Ph: (609) 927-1030 | Srisai Gowda Md Llc 2106 New Road D-8 Linwood NJ 08221 Ph: (609) 927-1030 |
| NPI Number | 1245361583 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 12/13/2019 |
| Certification Date | 12/13/2019 |
| Medicare PECOS PAC ID | 2466423678 |
|---|---|
| Medicare Enrollment ID | O20040803000024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245361583 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 25MA06553300 (New Jersey) | Primary |
| Provider Name | Srisai Gowda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801995352 PECOS PAC ID: 5698761757 Enrollment ID: I20040423000078 |
| Provider Name | Jinal T Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710464110 PECOS PAC ID: 7416200514 Enrollment ID: I20181018002141 |
| Provider Name | Mohammad Waqas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033755921 PECOS PAC ID: 0749610566 Enrollment ID: I20200420000463 |
| Provider Name | Ayeesha Adolphus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447885132 PECOS PAC ID: 2264854470 Enrollment ID: I20210406002282 |
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