Provider Demographics
NPI:1649354903
Name:SRINO BHARAM MD PC
Entity type:Organization
Organization Name:SRINO BHARAM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINO
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:212-691-3535
Mailing Address - Street 1:130 E. 77TH ST
Mailing Address - Street 2:8 FL BLACK HALL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-691-3535
Mailing Address - Fax:212-691-6370
Practice Address - Street 1:130 E. 77TH ST
Practice Address - Street 2:8 FL BLACK HALL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-691-3535
Practice Address - Fax:212-691-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203659207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02426126Medicaid
NY02426126Medicaid
WLW681Medicare PIN