Provider Demographics
NPI:1902198617
Name:MSSM(ELMHURST)
Entity Type:Organization
Organization Name:MSSM(ELMHURST)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE RESIDENT, PGY-III
Authorized Official - Prefix:
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAMKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-377-4312
Mailing Address - Street 1:8015 41ST AVE APT 437
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8001 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3160
Practice Address - Country:US
Practice Address - Phone:718-334-2490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital