Provider Demographics
NPI:1114167202
Name:KUCHIPUDI BAPINEEDU, MD PA
Entity Type:Organization
Organization Name:KUCHIPUDI BAPINEEDU, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAPINEEDU
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHIPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-796-4848
Mailing Address - Street 1:15-01 BROADWAY
Mailing Address - Street 2:STE. #22
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6003
Mailing Address - Country:US
Mailing Address - Phone:201-796-4848
Mailing Address - Fax:201-797-7992
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:STE. #22
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:201-796-4848
Practice Address - Fax:201-797-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34591208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3723500Medicaid
NJD06266Medicare UPIN
NJ156878Medicare PIN