Provider Demographics
NPI:1245452804
Name:VOLETI, VINOD BABU (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:BABU
Last Name:VOLETI
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 1:1000 GALLOPING HILL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7991
Mailing Address - Country:US
Mailing Address - Phone:905-458-8333
Mailing Address - Fax:
Practice Address - Street 1:1000 GALLOPING HILL RD STE 305
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7991
Practice Address - Country:US
Practice Address - Phone:908-458-8333
Practice Address - Fax:908-458-8339
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09244000207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFL534YMedicare PIN
CA0A1170970Medicaid