Basic Information
| Provider Information | |||||||||
| NPI: | 1144322561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURJONRAPPA | ||||||||
| FirstName: | SATHYAPRASAD | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 829642 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191829642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664706626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 PATERSON ST STE 3300 | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357821 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | C169195 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 253600 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 208600000X | 25MA08821500 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | ME136023 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 25MA08821500 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | NE0W8 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 100539000 | 05 | FL | MEDICAID |