1639124506 NPI number — MAHIPA HEWA PALLIMULLA MD

Table of content: MAHIPA HEWA PALLIMULLA MD (NPI 1639124506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639124506 NPI number — MAHIPA HEWA PALLIMULLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALLIMULLA
Provider First Name:
MAHIPA
Provider Middle Name:
HEWA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1639124506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 HAMBURG TPKE
Provider Second Line Business Mailing Address:
STE 21
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-570-2727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-790-8090
Provider Business Practice Location Address Fax Number:
973-790-3198
Provider Enumeration Date:
05/22/2006

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: 207V00000X , with the licence number:  25MA07089000 , 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: 1942421070 . This is a "GRP NPI SURGAIDE 1, LLC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 96127 . This is a "AMERIGROUP MEDICAID HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1356533624 . This is a "GRP NPI SURGAIDE 2, LLC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000416910 . This is a "AMERICHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2843436 . This is a "OXFORD HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1169311 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000416908 . This is a "AMERICHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0464125 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1790731271 . This is a "GRP NPI COMPREHENSIVE WOMEN'S HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3725083 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8327602 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01000416905 . This is a "AMERICHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000416900 . This is a "AMERICHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000416907 . This is a "AMERICHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2001661000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 987D31 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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