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General NPI Number Information
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NPI Number | 1871737155
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Entity Type | Individual
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Provider Name | PRATIMA R GONDIPALLI M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 140 PARK AVE
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1049
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Country | US
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Telephone | 973-404-9700
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Fax | 973-377-4709
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Provider Business Mailing Address
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Address Line | 175 N PASSAIC AVE
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City | CHATHAM
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State | NJ
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Zip | 07928-2611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA11115200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101268313
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 248078
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036.120727
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License Number State | IL
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