1457619421 NPI number — PURNA BINDU NANDIGAM MD

Table of content: PURNA BINDU NANDIGAM MD (NPI 1457619421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457619421 NPI number — PURNA BINDU NANDIGAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NANDIGAM
Provider First Name:
PURNA BINDU
Provider Middle Name:
Provider Name Prefix Text:
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:
1457619421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
246 HAMBURG TPKE
Provider Second Line Business Mailing Address:
SUITE #207
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-2156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-653-3366
Provider Business Mailing Address Fax Number:
973-653-3365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
SUITE #207
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-653-3366
Provider Business Practice Location Address Fax Number:
973-653-3365
Provider Enumeration Date:
04/27/2012

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 25MA09737700 , 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)





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