Provider Demographics
NPI:1982019774
Name:BALLACHANDA SUBBAIAH, TAARAN CARIAPPA (MD)
Entity Type:Individual
Prefix:
First Name:TAARAN CARIAPPA
Middle Name:
Last Name:BALLACHANDA SUBBAIAH
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 1:30 PROSPECT AVENUE
Mailing Address - Street 2:JOHNSON HALL (DEPT. OF INTERNAL MEDICINE)
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1915
Mailing Address - Country:US
Mailing Address - Phone:551-996-1330
Mailing Address - Fax:551-996-3298
Practice Address - Street 1:30 PROSPECT AVENUE
Practice Address - Street 2:JOHNSON HALL (DEPT. OF INTERNAL MEDICINE)
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-1330
Practice Address - Fax:551-996-3298
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10622400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA10622400OtherNJ DIVISION OF CONSUMER AFFAIRS, BOARD OF MEDICAL EXAMINERS