Provider Demographics
NPI:1336298389
Name:NORTHFIELD INTERNAL MEDICINE, PA
Entity Type:Organization
Organization Name:NORTHFIELD INTERNAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VISALA
Authorized Official - Middle Name:V
Authorized Official - Last Name:NANDURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-328-6736
Mailing Address - Street 1:13 BLUE BIRD CT
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2127
Mailing Address - Country:US
Mailing Address - Phone:973-992-0658
Mailing Address - Fax:973-992-6655
Practice Address - Street 1:315 E NORTHFIELD RD
Practice Address - Street 2:SUITE # 1D
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4896
Practice Address - Country:US
Practice Address - Phone:973-992-0658
Practice Address - Fax:973-992-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0110515Medicaid
NJ0110515Medicaid