Healthcare Provider Details

I. General information

NPI: 1114897352
Provider Name (Legal Business Name): MR. ABHIRAM RACHAMADUGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W 231ST ST
BRONX NY
10463-3940
US

IV. Provider business mailing address

280 W 231ST ST
BRONX NY
10463-3940
US

V. Phone/Fax

Practice location:
  • Phone: 718-514-6120
  • Fax: 718-360-0250
Mailing address:
  • Phone: 718-514-6120
  • Fax: 718-360-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: