Provider Demographics
NPI:1851403935
Name:SATHISH R. MODUGU MEDICAL PC
Entity Type:Organization
Organization Name:SATHISH R. MODUGU MEDICAL PC
Other - Org Name:SPORTS, SPINE & PAIN TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATHISH
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:MODUGU
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:914-681-9750
Mailing Address - Street 1:280 N CENTRAL AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1832
Mailing Address - Country:US
Mailing Address - Phone:914-681-9750
Mailing Address - Fax:914-681-9755
Practice Address - Street 1:280 N CENTRAL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1832
Practice Address - Country:US
Practice Address - Phone:914-681-9750
Practice Address - Fax:914-681-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty