Provider Demographics
NPI:1912357153
Name:CHELLAPILLA, VIJAYA (VIJAYA CHELLAPILLA)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:
Last Name:CHELLAPILLA
Suffix:
Gender:F
Credentials:VIJAYA CHELLAPILLA
Other - Prefix:DR
Other - First Name:VIJAYA
Other - Middle Name:
Other - Last Name:CHELLAPILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:96 COLES ST # 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2322
Mailing Address - Country:US
Mailing Address - Phone:201-484-0759
Mailing Address - Fax:
Practice Address - Street 1:96 COLES ST # 3
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2322
Practice Address - Country:US
Practice Address - Phone:201-484-0759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO6276000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine