Provider Demographics
NPI:1184070344
Name:SWATHI REDDY MD P C
Entity type:Organization
Organization Name:SWATHI REDDY MD P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SWATHI
Authorized Official - Middle Name:CHENNA
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-257-4549
Mailing Address - Street 1:9413 FLATLANDS AVE STE 205W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3718
Mailing Address - Country:US
Mailing Address - Phone:718-257-4549
Mailing Address - Fax:718-257-2347
Practice Address - Street 1:9413 FLATLANDS AVE STE 205W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3718
Practice Address - Country:US
Practice Address - Phone:718-257-4549
Practice Address - Fax:718-257-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04463232Medicaid
NY03299167Medicaid