Healthcare Provider Details

I. General information

NPI: 1699921502
Provider Name (Legal Business Name): PEDIATRICPRIORITYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 ROUTE 27 SUITE A
NORTH BRUNSWICK NJ
08902-5010
US

IV. Provider business mailing address

2864 ROUTE 27 SUITE A
NORTH BRUNSWICK NJ
08902-5010
US

V. Phone/Fax

Practice location:
  • Phone: 732-821-4770
  • Fax: 732-821-4848
Mailing address:
  • Phone: 732-821-4770
  • Fax: 732-821-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMA51412
License Number StateNJ

VIII. Authorized Official

Name: MARUTHI BALA VADAPALLI
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 732-821-4770