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General NPI Number Information
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NPI Number | 1396806600
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Entity Type | Organization
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Legal Business Name | SOLOMON KUCHIPUDI MD LLC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 636 EASTON AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-1975
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Country | US
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Telephone | 732-220-8811
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Fax | 732-220-1300
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Provider Business Mailing Address
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Address Line | 636 EASTON AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-1975
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Country | US
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Telephone | 732-220-8811
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Fax | 732-220-1300
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SOLOMON KUCHIPUDI
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Credential | M.D.
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Telephone | 732-220-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MA74312
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License Number State | NJ
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