1073688958 NPI number — VANI MADDALI MD LLC

Table of content: (NPI 1073688958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073688958 NPI number — VANI MADDALI MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANI MADDALI MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ESSEX MEDICAL CENTER MD PA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073688958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 SPRINGFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARSIPPANY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07054-2943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-316-5820
Provider Business Mailing Address Fax Number:
973-535-3406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 OLD SHORT HILLS RD
Provider Second Line Business Practice Location Address:
SUITE #108
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07039-5604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-535-5227
Provider Business Practice Location Address Fax Number:
973-535-3406
Provider Enumeration Date:
11/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MADDALI
Authorized Official First Name:
VANI
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D
Authorized Official Telephone Number:
973-535-5227

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MA07029100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8522600 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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