Provider Demographics
NPI:1598876369
Name:PATURU, VANAJAKSHI (MD)
Entity type:Individual
Prefix:DR
First Name:VANAJAKSHI
Middle Name:
Last Name:PATURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LA ROSA DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1724
Mailing Address - Country:US
Mailing Address - Phone:201-229-9589
Mailing Address - Fax:
Practice Address - Street 1:15-01 BROADWAY STE 10B
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6006
Practice Address - Country:US
Practice Address - Phone:201-794-7733
Practice Address - Fax:201-794-6039
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0703412084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8787808Medicaid
NJH28095Medicare UPIN
NJ8787808Medicaid