Healthcare Provider Details

I. General information

NPI: 1427245356
Provider Name (Legal Business Name): KAVITA S REDDY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W 57TH ST
NEW YORK NY
10019-2929
US

IV. Provider business mailing address

521 W 57TH ST
NEW YORK NY
10019-2929
US

V. Phone/Fax

Practice location:
  • Phone: 212-698-9581
  • Fax: 212-698-0373
Mailing address:
  • Phone: 212-698-9581
  • Fax: 212-698-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberCQP30823
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: