Provider Demographics
NPI:1962462390
Name:SIROYA, PUSHPLATA (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHPLATA
Middle Name:
Last Name:SIROYA
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 1:330 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4026
Mailing Address - Country:US
Mailing Address - Phone:718-369-1383
Mailing Address - Fax:718-963-6793
Practice Address - Street 1:330 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4026
Practice Address - Country:US
Practice Address - Phone:718-369-1383
Practice Address - Fax:718-963-6793
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168777207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15E891Medicare PIN