Healthcare Provider Details

I. General information

NPI: 1316995087
Provider Name (Legal Business Name): ISAAC JAYARAO ALAMURI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OLD COUNTRY RD
PLAINVIEW NY
11803-4914
US

IV. Provider business mailing address

23 BLOOMINGTON ST
MEDFORD NY
11763
US

V. Phone/Fax

Practice location:
  • Phone: 917-617-1365
  • Fax:
Mailing address:
  • Phone: 917-617-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236814
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: