Healthcare Provider Details

I. General information

NPI: 1609109792
Provider Name (Legal Business Name): HARITHA BODDULURI VEERAMACHANENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 FRANKLIN AVE, STE. 300 LONG ISLAND PLASTIC SURGICAL GROUP P.C
GARDEN CITY NY
11530
US

IV. Provider business mailing address

999 FRANKLIN AVE, STE. 300 LONG ISLAND PLASTIC SURGICAL GROUP P.C
GARDEN CITY NY
11530
US

V. Phone/Fax

Practice location:
  • Phone: 516-742-3404
  • Fax: 516-353-6734
Mailing address:
  • Phone: 516-742-3404
  • Fax: 516-353-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number275292-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: