Provider Demographics
NPI:1558334078
Name:REDDY, SARATH (MD)
Entity Type:Individual
Prefix:DR
First Name:SARATH
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 WILLOUGHBY ST
Mailing Address - Street 2:SUITE 11E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5465
Mailing Address - Country:US
Mailing Address - Phone:718-250-8627
Mailing Address - Fax:718-250-6703
Practice Address - Street 1:240 WILLOUGHBY ST
Practice Address - Street 2:SUITE 11E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5465
Practice Address - Country:US
Practice Address - Phone:718-250-8627
Practice Address - Fax:718-250-6703
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197190207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01740945Medicaid
NY02999GMedicare PIN
NY01740945Medicaid
NYG45384Medicare UPIN