Individual
VASANTHA KONDAMUDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
718 TEANECK RD, TEANECK, NJ 07666-4245
(201) 833-3000
Mailing address
3 UNIVERSITY PLZ STE 205, HACKENSACK, NJ 07601-6208
(201) 833-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
205727
NY
207Q00000X
Family Medicine Physician
Primary
25MA06681100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01841556
—
NY
Enumeration date
08/04/2006
Last updated
04/11/2023
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