Provider Demographics
NPI:1548395445
Name:NEDUVELIL, ROSHINI MARY (MD)
Entity Type:Individual
Prefix:
First Name:ROSHINI
Middle Name:MARY
Last Name:NEDUVELIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-1635
Mailing Address - Country:US
Mailing Address - Phone:718-834-8202
Mailing Address - Fax:
Practice Address - Street 1:120 RICHARDS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-1635
Practice Address - Country:US
Practice Address - Phone:718-834-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0530341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02783737Medicaid