Healthcare Provider Details

I. General information

NPI: 1225149693
Provider Name (Legal Business Name): RENUKA N MAPITIGAMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE STE 203
PARAMUS NJ
07652-2361
US

IV. Provider business mailing address

110 CHESTNUT RIDGE RD STE 394
MONTVALE NJ
07645-1706
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-1245
  • Fax: 201-444-8560
Mailing address:
  • Phone: 201-312-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA07536900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA07536900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA07536900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: