Provider Demographics
NPI:1134129448
Name:VADALI, RAJYALAKSHMI V (MD)
Entity type:Individual
Prefix:
First Name:RAJYALAKSHMI
Middle Name:V
Last Name:VADALI
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 1:1 IRENE CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2705
Mailing Address - Country:US
Mailing Address - Phone:732-679-0660
Mailing Address - Fax:732-679-7177
Practice Address - Street 1:1 IRENE CT
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2705
Practice Address - Country:US
Practice Address - Phone:732-679-0660
Practice Address - Fax:732-679-7177
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07248500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8924805Medicaid
NJ8924805Medicaid
G44576Medicare UPIN