Healthcare Provider Details

I. General information

NPI: 1346215225
Provider Name (Legal Business Name): SRINIVASA ESWARAPU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 WASHINGTON AVE
BELLEVILLE NJ
07109-3155
US

IV. Provider business mailing address

35 CALVERT AVE E
EDISON NJ
08820-3251
US

V. Phone/Fax

Practice location:
  • Phone: 973-450-9600
  • Fax: 973-450-4054
Mailing address:
  • Phone: 973-450-9600
  • Fax: 973-450-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA68009
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: