Provider Demographics
NPI:1780646646
Name:REDDY, ANUJA K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJA
Middle Name:K
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CELIA DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1802
Mailing Address - Country:US
Mailing Address - Phone:516-622-1192
Mailing Address - Fax:
Practice Address - Street 1:5314 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3609
Practice Address - Country:US
Practice Address - Phone:718-240-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02056875Medicaid
NYH09418Medicare UPIN
NY07118Medicare ID - Type UnspecifiedGHI MEDICARE
NY02056875Medicaid