Provider Demographics
NPI:1275531931
Name:PENUMADU, ARUNAKUMARI (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUNAKUMARI
Middle Name:
Last Name:PENUMADU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ARUNAKUMARI
Other - Middle Name:
Other - Last Name:TIMMIREDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30-27 30 ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:718-785-5785
Mailing Address - Fax:718-313-0664
Practice Address - Street 1:2510 30TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102-2448
Practice Address - Country:US
Practice Address - Phone:718-879-1651
Practice Address - Fax:718-267-6578
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246977207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02719419Medicaid
NYG400000795Medicare PIN