Provider Demographics
NPI:1558441923
Name:DIABETES ASSOCIATES P C
Entity Type:Organization
Organization Name:DIABETES ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-759-1111
Mailing Address - Street 1:5 FRANKLIN AVE
Mailing Address - Street 2:#609
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3532
Mailing Address - Country:US
Mailing Address - Phone:973-759-1111
Mailing Address - Fax:973-759-0894
Practice Address - Street 1:5 FRANKLIN AVE
Practice Address - Street 2:#609
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3532
Practice Address - Country:US
Practice Address - Phone:973-759-1111
Practice Address - Fax:973-759-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06283700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6950400Medicaid
NJ6950400Medicaid
NJG21262Medicare UPIN