Provider Demographics
NPI:1245287689
Name:SETRU, UDAYASHANKAR K (MD)
Entity type:Individual
Prefix:
First Name:UDAYASHANKAR
Middle Name:K
Last Name:SETRU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 BECKETT CLOSE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2413
Mailing Address - Country:US
Mailing Address - Phone:718-716-8381
Mailing Address - Fax:718-716-0054
Practice Address - Street 1:57 E MOUNT EDEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5806
Practice Address - Country:US
Practice Address - Phone:718-716-8381
Practice Address - Fax:718-716-0054
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY204478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01688559Medicaid
NY01688559Medicaid
G38095Medicare UPIN