Healthcare Provider Details

I. General information

NPI: 1508916255
Provider Name (Legal Business Name): SABHAPATHI ANASUYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 BRONX BLVD PEDIATRICS CLINIC, MONTEFIORE NORTH DIVISION
BRONX NY
10466-1515
US

IV. Provider business mailing address

4234 BRONX BOULEVARD PEDIATRICS CLINIC, MONTEFIORE NORTH DIVISION
BRONX NY
10466-1515
US

V. Phone/Fax

Practice location:
  • Phone: 347-341-4303
  • Fax:
Mailing address:
  • Phone: 347-341-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number192868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: