=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801843297
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMARAO GAJULA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 SAINT GEORGES AVE STE G
-----------------------------------------------------
City | AVENEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07001-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-382-8111
-----------------------------------------------------
Fax | 732-381-0292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 SAINT GEORGES AVE STE G
-----------------------------------------------------
City | AVENEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07001-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-382-8111
-----------------------------------------------------
Fax | 732-381-0292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 25MA0066859
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------