Provider Demographics
NPI:1912017260
Name:KURAPATI, NAGASIROMANI VENKATA (MD)
Entity Type:Individual
Prefix:
First Name:NAGASIROMANI
Middle Name:VENKATA
Last Name:KURAPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MANI
Other - Middle Name:V
Other - Last Name:KURAPATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4714 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-6550
Mailing Address - Country:US
Mailing Address - Phone:718-786-9595
Mailing Address - Fax:718-786-9595
Practice Address - Street 1:89 NOTTINGHAM RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2212
Practice Address - Country:US
Practice Address - Phone:516-437-1280
Practice Address - Fax:516-437-1280
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150722208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00715297Medicaid