Healthcare Provider Details

I. General information

NPI: 1730924184
Provider Name (Legal Business Name): VIJAY KUMAR MULAKALAPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 01/31/2026
Certification Date: 01/31/2026
Deactivation Date: 03/21/2025
Reactivation Date: 03/28/2025

III. Provider practice location address

HACKENSACK MERIDIAN HEALTH 30 PROSPECT AVENUE
HACKENSACK NJ
07601
US

IV. Provider business mailing address

60 2ND ST DEPT OF
HACKENSACK NJ
07601-2050
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-4257
  • Fax: 551-996-3298
Mailing address:
  • Phone: 551-996-2017
  • Fax: 551-996-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: