Sudhaker Rao Balmuri, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

17979 Issued in NJ

Practice address

343 Park Ave
Suite A5
East Orange, NJ 07017

Phone

(973) 414-8500

Fax

(973) 414-8500

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Dr. Sudhaker Rao Balmuri Professional name

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212537600000",
    "number": "1003824913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 PARK AVE",
            "address_2": "SUITE A5",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "07017",
            "telephone_number": "973-414-8500",
            "fax_number": "973-414-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 PARK AVE",
            "address_2": "SUITE A5",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "07017",
            "telephone_number": "973-414-8500",
            "fax_number": "973-414-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALMURI",
        "first_name": "SUDHAKER",
        "middle_name": "RAO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2008-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "17979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "741 BROADWAY",
            "identifier": "1740345693",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6130801",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "444 WILLIAMS ST",
            "identifier": "1194996645",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRVINGTON",
            "identifier": "1972778413",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "101 LUDLOW",
            "identifier": "1932370483",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUDHAKER",
            "last_name": "BALMURI",
            "middle_name": "RAO",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Dentist in East Orange, NJ
• Providers in East Orange, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.