Provider Demographics
NPI:1659929495
Name:EMPIRE STATE INTERNAL MEDICINE P C
Entity Type:Organization
Organization Name:EMPIRE STATE INTERNAL MEDICINE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARAVINDA
Authorized Official - Middle Name:LAKSHMI
Authorized Official - Last Name:BOMMAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-467-8183
Mailing Address - Street 1:5 ALCOTT CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6657
Mailing Address - Country:US
Mailing Address - Phone:914-467-8183
Mailing Address - Fax:
Practice Address - Street 1:2000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-6816
Practice Address - Country:US
Practice Address - Phone:914-737-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty