Provider Demographics
NPI:1255348421
Name:ENU, KARUVATH (MD)
Entity type:Individual
Prefix:DR
First Name:KARUVATH
Middle Name:
Last Name:ENU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534
Mailing Address - Country:US
Mailing Address - Phone:518-828-5200
Mailing Address - Fax:518-828-5427
Practice Address - Street 1:64 GREEN STREET
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534
Practice Address - Country:US
Practice Address - Phone:518-828-5200
Practice Address - Fax:518-828-5427
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110197208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00517322Medicaid
6628OtherWELLCARE
D00405849002OtherBCBS
10000582OtherCDPHP
10271OtherKAISER PERMANENTE
247124OtherMVP
KE06643730OtherEMPIRE
6628OtherGHI HMO
C11695Medicare UPIN
NY664371Medicare ID - Type Unspecified
NY00517322Medicaid