Healthcare Provider Details

I. General information

NPI: 1508791781
Provider Name (Legal Business Name): RAMKRISHNA GADDAM FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WATCHUNG WAY
BERKELEY HEIGHTS NJ
07922-2600
US

IV. Provider business mailing address

480 FABYAN PL APT 1L
NEWARK NJ
07112-1066
US

V. Phone/Fax

Practice location:
  • Phone: 908-771-5700
  • Fax:
Mailing address:
  • Phone: 929-235-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15558500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: