Healthcare Provider Details

I. General information

NPI: 1285015347
Provider Name (Legal Business Name): STATIONMD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 VALLEY ST STE 203
MAPLEWOOD NJ
07040-4300
US

IV. Provider business mailing address

515 VALLEY ST STE 203
MAPLEWOOD NJ
07040-4300
US

V. Phone/Fax

Practice location:
  • Phone: 908-663-2929
  • Fax: 908-934-9564
Mailing address:
  • Phone: 908-663-2929
  • Fax: 908-934-9564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEVEN UNADKAT
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 908-663-2929