Provider Demographics
NPI:1497161855
Name:HP MEDICAL PC
Entity Type:Organization
Organization Name:HP MEDICAL PC
Other - Org Name:TRU MEDICAL MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-335-0305
Mailing Address - Street 1:15 WILLIAM ST APT 16H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2938
Mailing Address - Country:US
Mailing Address - Phone:917-454-8474
Mailing Address - Fax:
Practice Address - Street 1:774 BROADWAY STE 2B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5316
Practice Address - Country:US
Practice Address - Phone:473-350-3053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WEX441Medicare PIN