Healthcare Provider Details

I. General information

NPI: 1275589202
Provider Name (Legal Business Name): RAMAKRISHNA GUDAPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 PROSPECT AVE APT 223
HACKENSACK NJ
07601-7763
US

IV. Provider business mailing address

310 PROSPECT AVE APT 223
HACKENSACK NJ
07601-7763
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-7484
  • Fax:
Mailing address:
  • Phone: 201-880-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA07691100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: