Individual
MADHAVI PENTYALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
22 OLD SHORT HILLS RD, SUITE 213, LIVINGSTON, NJ 07039-5604
(973) 992-0658
(973) 992-6655
Mailing address
1 SCHANCK DR, EDISON, NJ 08820-2417
(973) 992-0658
(973) 992-6655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA07939700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0079855
—
NJ
Enumeration date
05/02/2006
Last updated
05/20/2014
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