Provider Demographics
NPI:1952434052
Name:VADAKARA INTERNAL MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:VADAKARA INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VADAKARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-584-1001
Mailing Address - Street 1:2117 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3417
Mailing Address - Country:US
Mailing Address - Phone:609-584-1001
Mailing Address - Fax:609-584-0404
Practice Address - Street 1:2117 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3417
Practice Address - Country:US
Practice Address - Phone:609-584-1001
Practice Address - Fax:609-584-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
58765OtherAMERIGROUP
NJ8018006Medicaid
1110350OtherHORIZON NJ HEALTH
2144772001OtherKEYSTONE
2946AOtherUNIVERSITY HEALTH PLAN
1110350OtherHORIZON NJ HEALTH
2144772001OtherKEYSTONE