Provider Demographics
NPI:1881802700
Name:SRIVASTAVA, SATYA PRAKASH (CPO)
Entity type:Individual
Prefix:
First Name:SATYA
Middle Name:PRAKASH
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1409
Mailing Address - Country:US
Mailing Address - Phone:516-565-1519
Mailing Address - Fax:516-565-1519
Practice Address - Street 1:117 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1409
Practice Address - Country:US
Practice Address - Phone:516-565-1519
Practice Address - Fax:516-565-1519
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00930781Medicaid