Provider Demographics
NPI:1275820086
Name:SIRI MEDICAL & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SIRI MEDICAL & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMILA
Authorized Official - Middle Name:KUMARI
Authorized Official - Last Name:KOLISETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-644-4529
Mailing Address - Street 1:1870 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5473
Mailing Address - Country:US
Mailing Address - Phone:718-684-2516
Mailing Address - Fax:718-684-2518
Practice Address - Street 1:1870 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5473
Practice Address - Country:US
Practice Address - Phone:718-684-2516
Practice Address - Fax:718-684-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240104174400000X
NY258248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1639108285OtherNPI
NY1982798880OtherNPI