Healthcare Provider Details

I. General information

NPI: 1578026548
Provider Name (Legal Business Name): PRABHAT REDDY YETURU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

PO BOX 28082
NEW YORK NY
10087-8082
US

V. Phone/Fax

Practice location:
  • Phone: 212-987-3100
  • Fax: 212-876-3906
Mailing address:
  • Phone: 212-987-3100
  • Fax: 412-937-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3013528
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3013528
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: