MEDICARE: AMARESWARI KADIYAM M.D

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	207Q00000X	Family Medicine Physician	25MA09967800	NJ
2	207Q00000X	Family Medicine Physician	33168601	NY

General Provider Information

NPI Number	:	1568871754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARESWARI KADIYAM M.D

Provider Business Mailing Address
First Line	:	4 FRASCO LN
Second Line	:
City	:	NORWOOD
State	:	NJ
Zip	:	07648-2407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 ROUTE 303
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-2514
Country	:	US
Telephone Number	:	845-359-5005
Fax Number	:

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

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	07/31/2024

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