Healthcare Provider Details

I. General information

NPI: 1962036863
Provider Name (Legal Business Name): NAGA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 AMBOY AVE
METUCHEN NJ
08840-2456
US

IV. Provider business mailing address

328 AMBOY AVE
METUCHEN NJ
08840-2456
US

V. Phone/Fax

Practice location:
  • Phone: 469-257-3500
  • Fax:
Mailing address:
  • Phone: 469-257-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NAGAVALLI THIRUVALLUVAN
Title or Position: OWNER
Credential: NP
Phone: 469-257-3500