Provider Demographics
NPI:1033103882
Name:JAYARAM, NADUBEETHI (MD)
Entity Type:Individual
Prefix:DR
First Name:NADUBEETHI
Middle Name:
Last Name:JAYARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RALPH PL STE 102
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4405
Mailing Address - Country:US
Mailing Address - Phone:718-447-6545
Mailing Address - Fax:718-447-5297
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 102 RICHMOND ORTHOPAEDICS
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-447-6545
Practice Address - Fax:718-447-5297
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138690207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01838683Medicaid
NY01838683Medicaid
NY44F201Medicare PIN
NY44F201Medicare Oscar/Certification