Provider Demographics
NPI:1679303069
Name:SIVAM HEALTHCARE TRAINING INCORPORATED
Entity type:Organization
Organization Name:SIVAM HEALTHCARE TRAINING INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ERMAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, FNP-C, RD,
Authorized Official - Phone:973-373-9080
Mailing Address - Street 1:1120 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-1513
Mailing Address - Country:US
Mailing Address - Phone:973-373-9080
Mailing Address - Fax:973-373-9081
Practice Address - Street 1:1120 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-1513
Practice Address - Country:US
Practice Address - Phone:973-373-9080
Practice Address - Fax:973-373-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health