Provider Demographics
NPI:1881631729
Name:MADDATU, ELENITO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENITO
Middle Name:
Last Name:MADDATU
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 1:70 RAMTOWN GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3830
Mailing Address - Country:US
Mailing Address - Phone:732-785-0300
Mailing Address - Fax:732-785-9420
Practice Address - Street 1:70 RAMTOWN GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3830
Practice Address - Country:US
Practice Address - Phone:732-785-0300
Practice Address - Fax:732-785-9420
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05810200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics