Provider Demographics
NPI:1043490907
Name:PREMKUMAR RANGALA, MD PA
Entity type:Organization
Organization Name:PREMKUMAR RANGALA, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PREMKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-745-2989
Mailing Address - Street 1:251 POWERS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3028
Mailing Address - Country:US
Mailing Address - Phone:732-745-2989
Mailing Address - Fax:732-745-9072
Practice Address - Street 1:251 POWERS ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3028
Practice Address - Country:US
Practice Address - Phone:732-745-2989
Practice Address - Fax:732-745-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56502Medicare UPIN
NJ500734Medicare PIN