MEDICARE: MADDALI & ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1295496420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADDALI & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	2810 MORRIS AVE STE 202
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-4841
Country	:	US
Telephone Number	:	908-851-9292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 MORRIS AVE STE 202
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-4841
Country	:	US
Telephone Number	:	908-851-9292
Fax Number	:	908-851-9899

Authorized Official
Title or Position	:	PRESIDEN
Name	:	DR. KALYANI MADDALI
Credential	:	DDS
Telephone Number	:	201-232-9468

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	05/13/2022

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