Provider Demographics
NPI:1154621779
Name:DUDDUKURU, BALAJI
Entity type:Individual
Prefix:MR
First Name:BALAJI
Middle Name:
Last Name:DUDDUKURU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PLUM TREE CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5241
Mailing Address - Country:US
Mailing Address - Phone:917-754-9467
Mailing Address - Fax:
Practice Address - Street 1:6 PLUM TREE CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5241
Practice Address - Country:US
Practice Address - Phone:917-754-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444523183500000X
NJ28RI03355800183500000X
NY055298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist