MEDICARE: DR. HEBBALMATH M THIPPESWAMY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	125473	NY

General Provider Information

NPI Number	:	1285683771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEBBALMATH M THIPPESWAMY MD

Provider Business Mailing Address
First Line	:	2 CORACI BLVD
Second Line	:	SUITE # 9
City	:	SHIRLEY
State	:	NY
Zip	:	11967-4833
Country	:	US
Telephone Number	:	631-281-4861
Fax Number	:	631-281-8546

Provider Business Practice Location Address
First Line	:	2 CORACI BLVD
Second Line	:	SUITE # 9
City	:	SHIRLEY
State	:	NY
Zip	:	11967-4833
Country	:	US
Telephone Number	:	631-281-4861
Fax Number	:	631-281-8546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/09/2007

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