Provider Demographics
NPI: | 1831492792 |
---|---|
Name: | SRINIVASA REDDY MEDICAL PC |
Entity Type: | Organization |
Organization Name: | SRINIVASA REDDY MEDICAL PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MD |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SRINIVASA |
Authorized Official - Middle Name: | REDDY |
Authorized Official - Last Name: | ADAPA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 914-374-3851 |
Mailing Address - Street 1: | 123 LOGANS WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | HOPEWELL JUNCTION |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12533-3403 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-882-2432 |
Mailing Address - Fax: | 718-231-1067 |
Practice Address - Street 1: | 3950 WHITE PLAINS RD |
Practice Address - Street 2: | |
Practice Address - City: | BRONX |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10466-3026 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-882-2432 |
Practice Address - Fax: | 718-231-1067 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-12-15 |
Last Update Date: | 2013-01-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 218854 | 173000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 173000000X | Other Service Providers | Legal Medicine | Group - Single Specialty |