Provider Demographics
NPI:1457501363
Name:TIYYAGURA, SATISH REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:SATISH
Middle Name:REDDY
Last Name:TIYYAGURA
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 1:1 IRVING PL
Mailing Address - Street 2:V 12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9701
Mailing Address - Country:US
Mailing Address - Phone:917-405-1512
Mailing Address - Fax:
Practice Address - Street 1:22-18 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3016
Practice Address - Country:US
Practice Address - Phone:201-475-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-27
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231396207RC0000X
NJ25MA08393600207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology