| Organization Name: | VANITHA YADALLA MD LLC |
| NPI Number: | 1477919710 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VANITHA YADALLA (OWNER) |
| Mailing Address: | 3350 Rte 138 Suite 128, Bldg 2 Wall Township |
| State: | NJ US |
| Postal Code: | 077199693 |
| Phone Number: | 7322802727 |
| Fax Number: | 7322801147 |
| NPI Enumeration Date: | 12/31/2015 |
| NPI Last Update Date: | 12/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 25MA07674100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |