Healthcare Provider Details

I. General information

NPI: 1699710137
Provider Name (Legal Business Name): MAYA RAMAGOPAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FRENCH STREET SUITE 2218
NEW BRUNSWICK NJ
08903-0019
US

IV. Provider business mailing address

66 WEST GILBERT ST
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5201
  • Fax: 732-235-7707
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08165800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberD58018
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number25MA08165800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: