Provider Demographics
NPI:1073688958
Name:VANI MADDALI MD LLC
Entity Type:Organization
Organization Name:VANI MADDALI MD LLC
Other - Org Name:ESSEX MEDICAL CENTER MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:VANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-535-5227
Mailing Address - Street 1:29 SPRINGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2943
Mailing Address - Country:US
Mailing Address - Phone:973-316-5820
Mailing Address - Fax:973-535-3406
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE #108
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-535-5227
Practice Address - Fax:973-535-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07029100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8522600Medicaid
NJH34417Medicare UPIN
NJ8522600Medicaid