Healthcare Provider Details

I. General information

NPI: 1487957197
Provider Name (Legal Business Name): MEADOWLANDS PEDIATRIC HOSPITALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

1008 KINGS CT
WOODBRIDGE NJ
07095-3864
US

V. Phone/Fax

Practice location:
  • Phone: 973-980-8307
  • Fax:
Mailing address:
  • Phone: 973-980-8307
  • Fax: 201-773-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. RAMAPPA CHANDRA
Title or Position: OWNER
Credential: MD
Phone: 973-980-8307