Provider Demographics
NPI:1033110531
Name:PAKA, RENUKA D (MD)
Entity Type:Individual
Prefix:
First Name:RENUKA
Middle Name:D
Last Name:PAKA
Suffix:
Gender:F
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:PO BOX 95000-2243
Mailing Address - Street 2:OB-GYN ASSOCIATES OF SLR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2243
Mailing Address - Country:US
Mailing Address - Phone:516-338-5300
Mailing Address - Fax:516-338-1075
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1104
Practice Address - Country:US
Practice Address - Phone:212-581-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1864351207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01381364Medicaid
NY18L781Medicare ID - Type Unspecified
NY01381364Medicaid