1740407600 NPI number — VANAJA ASSOCIATES MD,P.C

Table of content: (NPI 1740407600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740407600 NPI number — VANAJA ASSOCIATES MD,P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANAJA ASSOCIATES MD,P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KURRA ASSOCIATES
Provider Other Organization Name Type Code:
4
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:
1740407600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 LA ROSA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE FERRY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07643-1724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-229-9589
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15-01 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 10 - B
Provider Business Practice Location Address City Name:
FAIR LAWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07410-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-794-7733
Provider Business Practice Location Address Fax Number:
201-794-6039
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATURU
Authorized Official First Name:
VANAJAKSHI
Authorized Official Middle Name:
Authorized Official Title or Position:
ATTENDING PHYSICIAN
Authorized Official Telephone Number:
201-952-3377

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MA070341 , 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: 8787808 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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