Provider Demographics
NPI:1093950677
Name:KAMADOLI, RIYAZ (MD)
Entity Type:Individual
Prefix:
First Name:RIYAZ
Middle Name:
Last Name:KAMADOLI
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:HSC T16 020
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8160
Mailing Address - Country:US
Mailing Address - Phone:631-444-1106
Mailing Address - Fax:631-444-2134
Practice Address - Street 1:HSC T16 020
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8160
Practice Address - Country:US
Practice Address - Phone:631-444-1106
Practice Address - Fax:631-444-2134
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine