Healthcare Provider Details

I. General information

NPI: 1275543027
Provider Name (Legal Business Name): PADMAJA ISUKAPALLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 PARK AVE SUITE 6 A
PLAINFIELD NJ
07060-3026
US

IV. Provider business mailing address

1024 PARK AVE SUITE 6 A
PLAINFIELD NJ
07060-3026
US

V. Phone/Fax

Practice location:
  • Phone: 908-222-8400
  • Fax: 908-222-8402
Mailing address:
  • Phone: 908-222-8400
  • Fax: 908-222-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07690000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier25MA07690000
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICAL LICENSE
# 2
IdentifierD08482300
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerCDS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: