Provider Demographics
NPI:1790051191
Name:ALLAM, NAVEEN REDDY (MD)
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:REDDY
Last Name:ALLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PARK ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2903
Mailing Address - Country:US
Mailing Address - Phone:973-746-0595
Mailing Address - Fax:
Practice Address - Street 1:73 PARK ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2903
Practice Address - Country:US
Practice Address - Phone:973-746-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09568900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine