Healthcare Provider Details

I. General information

NPI: 1831492792
Provider Name (Legal Business Name): SRINIVASA REDDY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 WHITE PLAINS RD
BRONX NY
10466-3026
US

IV. Provider business mailing address

123 LOGANS WAY
HOPEWELL JUNCTION NY
12533-3403
US

V. Phone/Fax

Practice location:
  • Phone: 718-882-2432
  • Fax: 718-231-1067
Mailing address:
  • Phone: 718-882-2432
  • Fax: 718-231-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number218854
License Number StateNY

VIII. Authorized Official

Name: SRINIVASA REDDY ADAPA
Title or Position: MD
Credential:
Phone: 914-374-3851