Healthcare Provider Details

I. General information

NPI: 1790709822
Provider Name (Legal Business Name): HEMALATHA RAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

20 TODT HILL CT
STATEN ISLAND NY
10304-1148
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-4408
  • Fax: 718-616-4105
Mailing address:
  • Phone: 718-980-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number155206-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: