Healthcare Provider Details

I. General information

NPI: 1114167202
Provider Name (Legal Business Name): KUCHIPUDI BAPINEEDU, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-01 BROADWAY STE. #22
FAIR LAWN NJ
07410-6003
US

IV. Provider business mailing address

15-01 BROADWAY STE. #22
FAIR LAWN NJ
07410-6003
US

V. Phone/Fax

Practice location:
  • Phone: 201-796-4848
  • Fax: 201-797-7992
Mailing address:
  • Phone: 201-796-4848
  • Fax: 201-797-7992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMA34591
License Number StateNJ

VIII. Authorized Official

Name: DR. BAPINEEDU KUCHIPUDI
Title or Position: SOLE PROPIETER
Credential: M.D.
Phone: 201-796-4848