Provider Demographics
NPI:1699921502
Name:PEDIATRICPRIORITYCARE
Entity type:Organization
Organization Name:PEDIATRICPRIORITYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARUTHI
Authorized Official - Middle Name:BALA
Authorized Official - Last Name:VADAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-821-4770
Mailing Address - Street 1:2864 ROUTE 27
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5010
Mailing Address - Country:US
Mailing Address - Phone:732-821-4770
Mailing Address - Fax:732-821-4848
Practice Address - Street 1:2864 ROUTE 27
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-5010
Practice Address - Country:US
Practice Address - Phone:732-821-4770
Practice Address - Fax:732-821-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA514122080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty