Basic Information
| Provider Information | |||||||||
| NPI: | 1881776193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SURAPANENI | ||||||||
| FirstName: | PADMAJA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 ANDERSON ST | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076014508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014873355 | ||||||||
| FaxNumber: | 2014870960 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 ANDERSON ST | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076014508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014873355 | ||||||||
| FaxNumber: | 2014870960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 25MA06805300 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.