Provider Demographics
NPI:1558315531
Name:REEMA MAINDIRATTA MD PC
Entity Type:Organization
Organization Name:REEMA MAINDIRATTA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINDIRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-3675
Mailing Address - Street 1:400 W MAIN ST STE 336
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3016
Mailing Address - Country:US
Mailing Address - Phone:631-422-3675
Mailing Address - Fax:631-422-3743
Practice Address - Street 1:400 W MAIN ST STE 336
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3016
Practice Address - Country:US
Practice Address - Phone:631-422-3675
Practice Address - Fax:631-422-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2032592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01766412Medicaid
NY480331Medicare ID - Type Unspecified
NYG58702Medicare UPIN