Healthcare Provider Details

I. General information

NPI: 1821096504
Provider Name (Legal Business Name): PADMAVATHI JONNALAGADDA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07307-4166
US

IV. Provider business mailing address

3438 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07307-4166
US

V. Phone/Fax

Practice location:
  • Phone: 201-420-0366
  • Fax: 201-420-6422
Mailing address:
  • Phone: 201-420-0366
  • Fax: 201-420-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07442900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA06324000
License Number StateNJ

VIII. Authorized Official

Name: PADMAVATHI JONNALAGADDA
Title or Position: PRESIDENT
Credential: MD
Phone: 201-420-0366