Provider Demographics
NPI:1497929038
Name:CENTER FOR INFECTIOUS DISEASES AND INTL. TRAVEL CARE OF MONMOUTH, P.C.
Entity Type:Organization
Organization Name:CENTER FOR INFECTIOUS DISEASES AND INTL. TRAVEL CARE OF MONMOUTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMANASRI
Authorized Official - Middle Name:V
Authorized Official - Last Name:KUDIPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-685-9243
Mailing Address - Street 1:31 YELLOW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1967
Mailing Address - Country:US
Mailing Address - Phone:732-682-9763
Mailing Address - Fax:732-631-9924
Practice Address - Street 1:901 WEST MAIN STREET SUITE 260,
Practice Address - Street 2:CN 5050,
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-685-9243
Practice Address - Fax:732-631-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07472000261QM2500X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8972401Medicaid
NJ8972401Medicaid
NJ064646DR7Medicare PIN