Healthcare Provider Details

I. General information

NPI: 1780676759
Provider Name (Legal Business Name): SITAMAHALAKSHMI YERRAMALLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA MAASS DR STE 200
BELLEVILLE NJ
07109-3550
US

IV. Provider business mailing address

1 CLARA MAASS DR STE 200
BELLEVILLE NJ
07109-3550
US

V. Phone/Fax

Practice location:
  • Phone: 973-751-8880
  • Fax: 973-751-8950
Mailing address:
  • Phone: 973-751-8880
  • Fax: 973-751-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA03850700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: