Healthcare Provider Details

I. General information

NPI: 1922749829
Provider Name (Legal Business Name): NAVEEN KUMAR REDDY AMBATI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 WILLOW OAKS CORPORATE DR FL 6
FAIRFAX VA
22031-4530
US

IV. Provider business mailing address

420 MOUNTAIN AVE FL 4
NEW PROVIDENCE NJ
07974-2736
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-9335
  • Fax: 703-207-0038
Mailing address:
  • Phone: 908-458-8333
  • Fax: 908-530-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101288603
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: