Provider Demographics
NPI:1134139801
Name:PRABHU, VASANTHI MUDRADI (MD)
Entity Type:Individual
Prefix:DR
First Name:VASANTHI
Middle Name:MUDRADI
Last Name:PRABHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KNOLCROFT RD
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NJ
Mailing Address - Zip Code:07939
Mailing Address - Country:US
Mailing Address - Phone:908-647-0180
Mailing Address - Fax:908-604-5250
Practice Address - Street 1:151 KNOLCROFT RD
Practice Address - Street 2:NEW JERSEY HEALTH CARE SYSTEM
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:908-604-5250
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04722900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine