Provider Demographics
NPI:1750476057
Name:CHARAIPOTRA, NEELAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELAM
Middle Name:
Last Name:CHARAIPOTRA
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 1:80 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-1323
Mailing Address - Country:US
Mailing Address - Phone:732-396-4744
Mailing Address - Fax:732-396-9604
Practice Address - Street 1:80 LAKE AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-1323
Practice Address - Country:US
Practice Address - Phone:732-396-4744
Practice Address - Fax:732-396-9604
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA042594002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD036018OtherCDS #
NJ25MA04259400OtherNJ STATE MEDICAL LICENSE
NJ3834808Medicaid
AC2333413OtherDEA#
D96949Medicare UPIN