Provider Demographics
NPI:1245238997
Name:PUSHPARAJ, NEELVATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELVATHY
Middle Name:
Last Name:PUSHPARAJ
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 1:64 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1120
Mailing Address - Country:US
Mailing Address - Phone:845-896-6203
Mailing Address - Fax:845-896-9104
Practice Address - Street 1:64 JACKSON ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1120
Practice Address - Country:US
Practice Address - Phone:845-896-6203
Practice Address - Fax:845-896-9104
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112007207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02074582Medicaid
NYB17300Medicare UPIN
NY02074582Medicaid