Provider Demographics
NPI:1417338997
Name:DAROORI, YADAGIRI
Entity Type:Individual
Prefix:
First Name:YADAGIRI
Middle Name:
Last Name:DAROORI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 EVERGREEN FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-2092
Mailing Address - Country:US
Mailing Address - Phone:305-215-7363
Mailing Address - Fax:
Practice Address - Street 1:1959 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4505
Practice Address - Country:US
Practice Address - Phone:718-824-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist