Provider Demographics
NPI:1568603090
Name:ALLIEDMEDIX RESOURCES INC
Entity Type:Organization
Organization Name:ALLIEDMEDIX RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRAMOULI
Authorized Official - Middle Name:L
Authorized Official - Last Name:METTAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:718-593-4121
Mailing Address - Street 1:3100 47TH AVE
Mailing Address - Street 2:SUITE 2120D SECOND FLOOR
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3013
Mailing Address - Country:US
Mailing Address - Phone:718-593-4121
Mailing Address - Fax:718-268-2646
Practice Address - Street 1:3100 47TH AVE
Practice Address - Street 2:SUITE 2120 D SECOND FLOOR
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3013
Practice Address - Country:US
Practice Address - Phone:718-593-4121
Practice Address - Fax:718-268-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X, 251B00000X
NY69300252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY69300Medicaid