Individual
PADMAVATHI JONNALAGADDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3438 JOHN F KENNEDY BLVD, JERSEY CITY, NJ 07307-4166
(201) 420-0366
(201) 420-6422
Mailing address
3438 JOHN F KENNEDY BLVD, JERSEY CITY, NJ 07307-4166
(201) 420-0366
(201) 420-6422
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
225330-1
NY
207R00000X
Internal Medicine Physician
Primary
25MA07442900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0036536
—
NJ
05
—
02511508
—
NY
01
—
043714808
HORIZON B/ C B/S
NJ
05
—
9006508
—
NJ
01
—
DB2462
RAILROAD MEDICARE GROUP #
NJ
01
—
P00089969
RAILROAD MEDICARE INDIVID
NJ
Enumeration date
07/07/2005
Last updated
01/25/2012
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