Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA03361100 | NJ |
N | 111NI0900X | Internist | 25MA03361100 | NJ |
N | 207RG0300X | Geriatric Medicine | 25MA03361100 | NJ |
NPI | 1093826216 |
---|---|
Provider Name | Dr. Jaladurga Prabhakararao Amuluru |
First Address | Livingston, NJ 07039-4906 |
Second Address | Hackensack, NJ 07601-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |