1417032855 NPI number — DR. ANURADHA YELCHUR MD

Table of content: DR. ANURADHA YELCHUR MD (NPI 1417032855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417032855 NPI number — DR. ANURADHA YELCHUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YELCHUR
Provider First Name:
ANURADHA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1417032855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 QUEENS PASS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTS NECK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07722-1760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-308-4396
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 MAIN STREET
Provider Second Line Business Practice Location Address:
INSTACARE MEDICAL CENTER
Provider Business Practice Location Address City Name:
SOUTH RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-254-8400
Provider Business Practice Location Address Fax Number:
732-254-8484
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA68120 , 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: 7851502 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com