Provider Demographics
NPI:1730296385
Name:REDDY, MUNAGALA J (MD)
Entity Type:Individual
Prefix:
First Name:MUNAGALA
Middle Name:J
Last Name:REDDY
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 1:180 EAST PENN STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4264
Mailing Address - Country:US
Mailing Address - Phone:516-431-2277
Mailing Address - Fax:516-431-8596
Practice Address - Street 1:180 EAST PENN STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4264
Practice Address - Country:US
Practice Address - Phone:516-431-2277
Practice Address - Fax:516-431-8596
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY127966207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00823607Medicaid
C06387Medicare UPIN
NY00823607Medicaid