Basic Information
| Provider Information | |||||||||
| NPI: | 1982019774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALLACHANDA SUBBAIAH | ||||||||
| FirstName: | TAARAN CARIAPPA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 PROSPECT AVENUE | ||||||||
| Address2: | JOHNSON HALL (DEPT. OF INTERNAL MEDICINE) | ||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519961330 | ||||||||
| FaxNumber: | 5519963298 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 PROSPECT AVENUE | ||||||||
| Address2: | JOHNSON HALL (DEPT. OF INTERNAL MEDICINE) | ||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519961330 | ||||||||
| FaxNumber: | 5519963298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA10622400 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 25MA10622400 | 01 | NJ | NJ DIVISION OF CONSUMER AFFAIRS, BOARD OF MEDICAL EXAMINERS | OTHER |