Provider Demographics
NPI:1902855968
Name:ADUSUMILLI, PADMASHREE S (MD)
Entity Type:Individual
Prefix:
First Name:PADMASHREE
Middle Name:S
Last Name:ADUSUMILLI
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 1:2 STONEHEDGE CT
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6939
Mailing Address - Country:US
Mailing Address - Phone:732-505-5123
Mailing Address - Fax:732-818-4843
Practice Address - Street 1:14 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6402
Practice Address - Country:US
Practice Address - Phone:732-505-5123
Practice Address - Fax:732-818-4843
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06711900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7880308Medicaid
NJG86443Medicare UPIN
NJ057462Medicare ID - Type Unspecified