Provider Demographics
NPI:1144566456
Name:GUNTUPALLI, MADAN M
Entity Type:Individual
Prefix:DR
First Name:MADAN
Middle Name:M
Last Name:GUNTUPALLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3702
Mailing Address - Country:US
Mailing Address - Phone:914-476-6060
Mailing Address - Fax:914-969-4108
Practice Address - Street 1:2 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3702
Practice Address - Country:US
Practice Address - Phone:914-476-6060
Practice Address - Fax:914-969-4108
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057614183500000X
NJ28RIO3424300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist