Provider Demographics
NPI:1003280470
Name:SEETARAM, STANLEY (ANCILLARY PROVIDER)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:SEETARAM
Suffix:
Gender:M
Credentials:ANCILLARY PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 FTELEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2801
Mailing Address - Country:US
Mailing Address - Phone:347-743-8258
Mailing Address - Fax:
Practice Address - Street 1:1263 FTELEY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2801
Practice Address - Country:US
Practice Address - Phone:347-743-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NO LICENSE NUMBER246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy