Provider Demographics
NPI:1518922939
Name:ITTEERA, ANNUPRIYA (MD)
Entity Type:Individual
Prefix:
First Name:ANNUPRIYA
Middle Name:
Last Name:ITTEERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNUPRIYA
Other - Middle Name:
Other - Last Name:OOMMEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:54 OLD FIELD LANE
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11020
Mailing Address - Country:US
Mailing Address - Phone:516-974-6072
Mailing Address - Fax:
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2521
Practice Address - Country:US
Practice Address - Phone:516-974-6072
Practice Address - Fax:516-998-4113
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2302272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02533553Medicaid
02981HOtherGHI
NY02533553Medicaid