Provider Demographics
NPI:1598881526
Name:PINNAMANENI, SARETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SARETH
Middle Name:
Last Name:PINNAMANENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 YUKON CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4162
Mailing Address - Country:US
Mailing Address - Phone:631-643-0777
Mailing Address - Fax:
Practice Address - Street 1:1500 OCEAN AVE STE C
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1924
Practice Address - Country:US
Practice Address - Phone:631-589-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS194215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102830OtherVYTRA
NY194215 AIOOtherHEALTH FIRST
NY5997959OtherGHI
NY174920POtherHIP
NY043706821OtherMAGNACARE
NY043706821OtherHORIZON BLUECROSS
NY043706821OtherUNITED HEALTH CARE
NY515731OtherEMPIRE BC HMO
NY04370684OtherGREATWESTERN
NY32BJOtherEMPIRE PPO-EPO
NY393484-006OtherCIGNA
NYP-2712164OtherOXFORD
NY5997959OtherGHI
NY194215 AIOOtherHEALTH FIRST