Provider Demographics
NPI:1043466774
Name:MAINDIRATTA, REEMA (MD)
Entity Type:Individual
Prefix:DR
First Name:REEMA
Middle Name:
Last Name:MAINDIRATTA
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 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 336
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3012
Mailing Address - Country:US
Mailing Address - Phone:631-422-3675
Mailing Address - Fax:631-422-3743
Practice Address - Street 1:400 W. MAIN STREET
Practice Address - Street 2:SUITE 336
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-422-3675
Practice Address - Fax:631-422-3743
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2032592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3099964OtherGHI
NYP670493OtherOXFORD
NY01766412Medicaid
NY2010522OtherUSHC
NY32986POtherHIP
NY00S31OtherEMPIRE BC/BS PPO
NY130020366OtherRAILROAD MEDICARE
NY2C2173OtherHEALTHNET
NYP-52814576OtherMULTIPLAN
NY5288634OtherAETNA
NY130020366OtherRAILROAD MEDICARE
NY32986POtherHIP