Provider Demographics
NPI:1275693491
Name:KARUVATH ENU MD PC
Entity Type:Organization
Organization Name:KARUVATH ENU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARUVATH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-828-5200
Mailing Address - Street 1:64 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2328
Mailing Address - Country:US
Mailing Address - Phone:518-828-5200
Mailing Address - Fax:518-828-5427
Practice Address - Street 1:64 GREEN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2328
Practice Address - Country:US
Practice Address - Phone:518-828-5200
Practice Address - Fax:518-828-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00517322Medicaid
NY664371Medicare ID - Type Unspecified
NY00517322Medicaid
NYAA1327Medicare PIN