Healthcare Provider Details

I. General information

NPI: 1093702961
Provider Name (Legal Business Name): VANITHA YADALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANITHA SEENIVASAN MD

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 RTE 138 STE 117
WALL TOWNSHIP NJ
07719-9694
US

IV. Provider business mailing address

3350 RTE 138 STE 117
WALL TOWNSHIP NJ
07719-9694
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-2727
  • Fax:
Mailing address:
  • Phone: 732-280-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07674100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25MA07674100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number25MA07674100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: