Healthcare Provider Details

I. General information

NPI: 1659460509
Provider Name (Legal Business Name): SANGEETA BUDDALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT. 72 EAST NEW LISBON DEVELOPMENTAL CENTER
NEW LISBON NJ
08064
US

IV. Provider business mailing address

7 SHOREHAM CT
EAST WINDSOR NJ
08520-5101
US

V. Phone/Fax

Practice location:
  • Phone: 609-726-1000
  • Fax:
Mailing address:
  • Phone: 609-371-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MAO7340500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: