Provider Demographics
NPI:1548556095
Name:NAGELI, SUBBA NAIDU
Entity type:Individual
Prefix:
First Name:SUBBA
Middle Name:NAIDU
Last Name:NAGELI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5022
Mailing Address - Country:US
Mailing Address - Phone:347-260-9089
Mailing Address - Fax:201-863-0637
Practice Address - Street 1:4300 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5022
Practice Address - Country:US
Practice Address - Phone:347-260-9089
Practice Address - Fax:201-863-0637
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20-055636183500000X
NJ28RI03193900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist