Healthcare Provider Details

I. General information

NPI: 1912926007
Provider Name (Legal Business Name): N.R. MEDICAL, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ADAM CLAYTON POWELL JR. BLVD.
NEW YORK NY
10026
US

IV. Provider business mailing address

174 GRAND ST
WHITE PLAINS NY
10601-4803
US

V. Phone/Fax

Practice location:
  • Phone: 212-864-1500
  • Fax: 212-864-0500
Mailing address:
  • Phone: 914-328-8077
  • Fax: 914-328-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number141334
License Number StateNY

VIII. Authorized Official

Name: DR. NAGAVENI RAO
Title or Position: MD.
Credential: MD
Phone: 212-864-1500