Healthcare Provider Details

I. General information

NPI: 1497929038
Provider Name (Legal Business Name): CENTER FOR INFECTIOUS DISEASES AND INTL. TRAVEL CARE OF MONMOUTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WEST MAIN STREET SUITE 260, CN 5050,
FREEHOLD NJ
07728
US

IV. Provider business mailing address

31 YELLOW BROOK RD
HOLMDEL NJ
07733-1967
US

V. Phone/Fax

Practice location:
  • Phone: 732-685-9243
  • Fax: 732-631-9924
Mailing address:
  • Phone: 732-682-9763
  • Fax: 732-631-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25MA07472000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number25MA07472000
License Number StateNJ

VIII. Authorized Official

Name: DR. RAMANASRI V. KUDIPUDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-685-9243