Healthcare Provider Details

I. General information

NPI: 1881799450
Provider Name (Legal Business Name): VASUNDHARA PUTCHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 COLUMBIA TPKE SUITE304
FLORHAM PARK NJ
07932-2113
US

IV. Provider business mailing address

8 VANDERBILT DRIVE
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 973-966-9090
  • Fax: 973-966-9777
Mailing address:
  • Phone: 973-535-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMA56075
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: