Provider Demographics
NPI:1225321250
Name:KEDIKA, SATISHKIRAN REDDY (MD)
Entity Type:Individual
Prefix:
First Name:SATISHKIRAN
Middle Name:REDDY
Last Name:KEDIKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SATISH
Other - Middle Name:
Other - Last Name:KEDIKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1511 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5568
Mailing Address - Country:US
Mailing Address - Phone:908-561-9500
Mailing Address - Fax:
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-445-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA103693002086S0129X
NY2853102086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty