Healthcare Provider Details

I. General information

NPI: 1366428765
Provider Name (Legal Business Name): SREENIVASA L MURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 BENEDICT AVE
BRONX NY
10462-4404
US

IV. Provider business mailing address

2034 BENEDICT AVE
BRONX NY
10462-4404
US

V. Phone/Fax

Practice location:
  • Phone: 718-822-6262
  • Fax: 718-822-2088
Mailing address:
  • Phone: 718-822-6262
  • Fax: 718-822-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number135741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: