Healthcare Provider Details

I. General information

NPI: 1932769262
Provider Name (Legal Business Name): KOMANDUR THRUPTHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

336 WEXFORD LN
HORSEHEADS NY
14845-1384
US

V. Phone/Fax

Practice location:
  • Phone: 346-710-2080
  • Fax:
Mailing address:
  • Phone: 346-710-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD485509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: