Healthcare Provider Details

I. General information

NPI: 1992744767
Provider Name (Legal Business Name): SARATH BABU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SARATHBABU YADDANAPUDI MD

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W PROSPECT ST STE 101
EAST BRUNSWICK NJ
08816-5711
US

IV. Provider business mailing address

51 W PROSPECT ST STE 101
EAST BRUNSWICK NJ
08816-5711
US

V. Phone/Fax

Practice location:
  • Phone: 732-249-3100
  • Fax: 732-249-7787
Mailing address:
  • Phone: 732-249-3100
  • Fax: 732-249-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06622000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: