1790533081 NPI number — MR. UJWAL SAI BOPPANA M.D.

Table of content: MR. UJWAL SAI BOPPANA M.D. (NPI 1790533081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790533081 NPI number — MR. UJWAL SAI BOPPANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOPPANA
Provider First Name:
UJWAL
Provider Middle Name:
SAI
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1790533081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/10/2025
NPI Reactivation Date:
01/27/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 PROSPECT AVENUE
Provider Second Line Business Mailing Address:
3620 MAIN BUILDING
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
551-996-2000
Provider Business Mailing Address Fax Number:
551-996-0937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 PROSPECT AVE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
551-996-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2024

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: "Y" .

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