MEDICARE: DR. NEELAM CHARAIPOTRA MD

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	2080A0000X	Pediatric Adolescent Medicine Physician	25MA04259400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D036018	OTHER	NJ	CDS #
2	25MA04259400	OTHER	NJ	NJ STATE MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750476057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEELAM CHARAIPOTRA MD

Provider Business Mailing Address
First Line	:	80 LAKE AVE
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-1323
Country	:	US
Telephone Number	:	732-396-4744
Fax Number	:	732-396-9604

Provider Business Practice Location Address
First Line	:	80 LAKE AVE
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-1323
Country	:	US
Telephone Number	:	732-396-4744
Fax Number	:	732-396-9604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/07/2023

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