Provider Demographics
NPI:1679148043
Name:SANGARAJU, KOUSHIK VARMA
Entity Type:Individual
Prefix:
First Name:KOUSHIK
Middle Name:VARMA
Last Name:SANGARAJU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CHANDRA APARTMENT SAPTHAGIRI NAGAR A-CAMP
Mailing Address - Street 2:
Mailing Address - City:KUMOOL
Mailing Address - State:ANDHRA PRADESH
Mailing Address - Zip Code:518002
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STATEN ISLAND UNIVERSITY HOSPITAL
Practice Address - Street 2:475 SEAVIEW AVENUE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program