Provider Demographics
NPI:1356013932
Name:ROJASUDHA VATTI MEDICAL OFFICE PC
Entity type:Organization
Organization Name:ROJASUDHA VATTI MEDICAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROJASUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-278-0701
Mailing Address - Street 1:2849 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4332
Mailing Address - Country:US
Mailing Address - Phone:718-280-0701
Mailing Address - Fax:718-278-0963
Practice Address - Street 1:2849 37TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4332
Practice Address - Country:US
Practice Address - Phone:718-278-0701
Practice Address - Fax:718-278-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty