Provider Demographics
NPI:1952370819
Name:BOLLU, JANARDHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANARDHAN
Middle Name:
Last Name:BOLLU
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:PO BOX 7107
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-7107
Mailing Address - Country:US
Mailing Address - Phone:973-754-9600
Mailing Address - Fax:973-754-6700
Practice Address - Street 1:32 HINE ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2955
Practice Address - Country:US
Practice Address - Phone:973-754-9600
Practice Address - Fax:973-754-9700
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059857207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7135106Medicaid
NJ7135106Medicaid
NJ100305Medicare PIN