Provider Demographics
NPI:1700996071
Name:SRIVASTAVA, AMRITA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMRITA
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
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:PO BOX 7490
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-7490
Mailing Address - Country:US
Mailing Address - Phone:718-780-5246
Mailing Address - Fax:
Practice Address - Street 1:506 6TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-246-8600
Practice Address - Fax:718-246-8601
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221415207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02801430Medicaid
NY02801430Medicaid