Provider Demographics
NPI:1932433364
Name:ENDO-METABOLIC PRACTICE PLLC
Entity Type:Organization
Organization Name:ENDO-METABOLIC PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SESHADRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MRCP, FAC
Authorized Official - Phone:718-273-5522
Mailing Address - Street 1:45 LITTLE CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4306
Mailing Address - Country:US
Mailing Address - Phone:718-273-5522
Mailing Address - Fax:718-273-6522
Practice Address - Street 1:47 LITTLE CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4306
Practice Address - Country:US
Practice Address - Phone:718-273-5522
Practice Address - Fax:718-273-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1578461207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100023652Medicare PIN