Healthcare Provider Details

I. General information

NPI: 1962643874
Provider Name (Legal Business Name): UMA VISWANATHAN, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BALTIMORE AVE
ROSELLE NJ
07203-2309
US

IV. Provider business mailing address

815 BALTIMORE AVE
ROSELLE NJ
07203-2309
US

V. Phone/Fax

Practice location:
  • Phone: 908-245-3446
  • Fax: 908-245-9265
Mailing address:
  • Phone: 908-245-3446
  • Fax: 908-245-9265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08394300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06880000
License Number StateNJ

VIII. Authorized Official

Name: MR. RAM VISWANATHAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 908-245-3446