Provider Demographics
NPI:1376867648
Name:KORAPATI, MAHENDER
Entity Type:Individual
Prefix:MR
First Name:MAHENDER
Middle Name:
Last Name:KORAPATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CREST RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2804
Mailing Address - Country:US
Mailing Address - Phone:732-390-2034
Mailing Address - Fax:
Practice Address - Street 1:14 CREST RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2804
Practice Address - Country:US
Practice Address - Phone:732-390-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047067183500000X
NJ28RI02461200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist