Provider Demographics
NPI:1932171451
Name:SOMAREDDY, VINOD Y (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:VINOD
Middle Name:Y
Last Name:SOMAREDDY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 NORTHERN BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4802
Mailing Address - Country:US
Mailing Address - Phone:516-829-0030
Mailing Address - Fax:516-466-7723
Practice Address - Street 1:475 NORTHERN BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4802
Practice Address - Country:US
Practice Address - Phone:516-829-0030
Practice Address - Fax:516-466-7723
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023119-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227741Medicaid
NY168391OtherELDERPLAN
NY2153187OtherUNITED HEALTHCARE
NY9442659OtherCIGNA PPO
NY00000091742OtherBETTERHEALTH
NY1961313OtherFIRSTHEALTH
NY7619OtherCAPITOL
NY023119OtherVYTRA HEALTHPLANS
NY53885POtherHIP HEALTHPLANS
NYP2540752OtherOXFORD HEALTHPLANS
NYQT1321OtherBLUE CROSS BLUE SHIELD
NY080023119NY03OtherANTHEM
NY080023119NY03OtherANTHEM
NY53885POtherHIP HEALTHPLANS