Provider Demographics
NPI:1598840977
Name:PEDIATRIC ASSOC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOC
Other - Org Name:USHA DEVI VEERAMACHANENI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:USHA
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:VEERAMACHANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-628-3477
Mailing Address - Street 1:824 RTE 6
Mailing Address - Street 2:DALMAX FORUM BUILDING
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541
Mailing Address - Country:US
Mailing Address - Phone:845-628-3477
Mailing Address - Fax:845-682-1285
Practice Address - Street 1:824 RTE 6
Practice Address - Street 2:DALMAX FORUM BUILDING
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541
Practice Address - Country:US
Practice Address - Phone:845-628-3477
Practice Address - Fax:845-682-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1565242080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60696Medicare UPIN