1538162656 NPI number — VIJAYA S LAKSHMI-REDDY M.D.

Table of content: VIJAYA S LAKSHMI-REDDY M.D. (NPI 1538162656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538162656 NPI number — VIJAYA S LAKSHMI-REDDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKSHMI-REDDY
Provider First Name:
VIJAYA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1538162656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 STIRLING RD STE 205
Provider Second Line Business Mailing Address:
SURGICARE ANESTHESIA OF CENTRAL JERSEY
Provider Business Mailing Address City Name:
WATCHUNG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07069-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-769-1084
Provider Business Mailing Address Fax Number:
908-769-4139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 STIRLING RD STE 205
Provider Second Line Business Practice Location Address:
SURGICARE ANESTHESIA OF CENTRAL JERSEY
Provider Business Practice Location Address City Name:
WATCHUNG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07069-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-769-1084
Provider Business Practice Location Address Fax Number:
908-769-4139
Provider Enumeration Date:
05/23/2005

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: 174400000X , with the licence number:  MA 68188 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: MA68188 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8630909 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".