1730924184 NPI number — MR. VIJAY KUMAR MULAKALAPALLI

Table of content: MR. VIJAY KUMAR MULAKALAPALLI (NPI 1730924184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730924184 NPI number — MR. VIJAY KUMAR MULAKALAPALLI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULAKALAPALLI
Provider First Name:
VIJAY
Provider Middle Name:
KUMAR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1730924184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2025
NPI Reactivation Date:
03/28/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 SECOND STREET, DEPARTMENT OF ACADEMIC AFFAIRS
Provider Second Line Business Mailing Address:
SUITE 105 1ST FLOOR (HILLCREST 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:
551-996-2017
Provider Business Mailing Address Fax Number:
551-996-0858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HACKENSACK MERIDIAN HEALTH
Provider Second Line Business Practice Location Address:
30 PROSPECT AVENUE
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:
551-996-4257
Provider Business Practice Location Address Fax Number:
551-996-3298
Provider Enumeration Date:
06/27/2024

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: 235Z00000X , with the licence number:  19286 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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