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General NPI Number Information
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NPI Number | 1962031450
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Entity Type | Individual
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Provider Name | TINA VRIDHACHALAM
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Gender | Female
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 333 15TH ST FL 2R
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City | HOBOKEN
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State | NJ
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Zip | 07030-3429
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Country | US
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Telephone | 201-482-9770
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Fax |
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Provider Business Mailing Address
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Address Line | 3286 41ST ST APT 3A
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City | ASTORIA
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State | NY
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Zip | 11103-3501
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Country | US
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Telephone | 646-755-0035
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA11800700
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License Number State | NJ
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