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General NPI Number Information
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NPI Number | 1205881190
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Entity Type | Organization
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Legal Business Name | JANARDHAN BOLLU MD PA
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 32 HINE ST
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City | PATERSON
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State | NJ
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Zip | 07503-2955
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Country | US
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Telephone | 973-754-9600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7107
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City | COLONIA
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State | NJ
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Zip | 07067-7107
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Country | US
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Telephone | 973-754-9600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANARDHAN BOLLU
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Credential | MD
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Telephone | 973-754-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MA059857
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License Number State | NJ
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