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NPI Code Detail

MEDICARE: DR. PADMAVATHY ALLI D.O

MEDICARE: DR. PADMAVATHY ALLI D.O
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
1208600000XSurgery PhysicianMB63954NJ

General Provider Information

NPI Number : 1891869483
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PADMAVATHY ALLI D.O
Provider Business Mailing Address
First Line : 557 BROAD ST
Second Line : SUITE 22
City : BLOOMFIELD
State : NJ
Zip : 07003-2885
Country : US
Telephone Number : 973-429-9844
Fax Number : 973-429-9858
Provider Business Practice Location Address
First Line : 557 BROAD ST
Second Line : SUITE 22
City : BLOOMFIELD
State : NJ
Zip : 07003-2885
Country : US
Telephone Number : 973-429-9844
Fax Number : 973-429-9858
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2006
Last Update Date : 07/08/2007

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