Healthcare Provider Details

I. General information

NPI: 1003843780
Provider Name (Legal Business Name): V G BYAHATTI MD PRAMILA BYAHATTI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 PARK AVE STE 103
SOUTH PLAINFIELD NJ
07080-5530
US

IV. Provider business mailing address

1907 PARK AVE STE 103
SOUTH PLAINFIELD NJ
07080-5530
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-2227
  • Fax: 908-668-0455
Mailing address:
  • Phone: 908-756-2227
  • Fax: 908-668-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA02794100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA02794100
License Number StateNJ

VIII. Authorized Official

Name: VEERAPPA G BYAHATTI
Title or Position: PRESIDENT
Credential:
Phone: 908-756-2227