Provider Demographics
NPI:1184783490
Name:CHUNDRU, VASUDHA
Entity type:Individual
Prefix:
First Name:VASUDHA
Middle Name:
Last Name:CHUNDRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:574 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1001
Practice Address - Country:US
Practice Address - Phone:908-518-3743
Practice Address - Fax:908-228-3621
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06628300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8260303Medicaid
NJ8260303Medicaid
NJ041852CDGMedicare PIN
NJ041852UA1Medicare PIN