Provider Demographics
NPI:1568754638
Name:KONERU, MYTHILI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MYTHILI
Middle Name:
Last Name:KONERU
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6102
Mailing Address - Country:US
Mailing Address - Phone:646-962-2357
Mailing Address - Fax:646-962-0115
Practice Address - Street 1:520 E 70TH ST
Practice Address - Street 2:STARR 341
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:646-962-2357
Practice Address - Fax:646-962-0115
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261368207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine