Provider Demographics
NPI:1003843780
Name:V G BYAHATTI MD PRAMILA BYAHATTI MD PA
Entity Type:Organization
Organization Name:V G BYAHATTI MD PRAMILA BYAHATTI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VEERAPPA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BYAHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-756-2227
Mailing Address - Street 1:1907 PARK AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5530
Mailing Address - Country:US
Mailing Address - Phone:908-756-2227
Mailing Address - Fax:908-668-0455
Practice Address - Street 1:1907 PARK AVE
Practice Address - Street 2:STE 103
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5530
Practice Address - Country:US
Practice Address - Phone:908-756-2227
Practice Address - Fax:908-668-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02794100207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2902206Medicaid
BY109970Medicare ID - Type Unspecified
NJ2902206Medicaid