Provider Demographics
NPI:1689833485
Name:JEEREDDY, BHAVANI (MD)
Entity type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:
Last Name:JEEREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1626
Mailing Address - Country:US
Mailing Address - Phone:908-276-9595
Mailing Address - Fax:
Practice Address - Street 1:66 S 21ST ST
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1626
Practice Address - Country:US
Practice Address - Phone:908-276-9595
Practice Address - Fax:908-276-6807
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08409200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine