Provider Demographics
NPI:1902014525
Name:KOMATI, NAGA MALLESWARI (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGA
Middle Name:MALLESWARI
Last Name:KOMATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NAGA
Other - Middle Name:MALLESWARI
Other - Last Name:BODAPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:767 NORTHFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1194
Mailing Address - Country:US
Mailing Address - Phone:973-992-9022
Mailing Address - Fax:973-992-9024
Practice Address - Street 1:767 NORTHFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1194
Practice Address - Country:US
Practice Address - Phone:973-419-0417
Practice Address - Fax:862-766-5904
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08336000207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0169790Medicaid
NJP00778377OtherRR MEDICARE
NJ0169790Medicaid
NJ131187UXWMedicare PIN
NJ131187TS6Medicare PIN