Healthcare Provider Details

I. General information

NPI: 1609701481
Provider Name (Legal Business Name): KAMAL ADDAGATLA MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WESTCHESTER AVE STE S512
RYE BROOK NY
10573-1369
US

IV. Provider business mailing address

222 PURCHASE ST UNIT 338
RYE NY
10580-2101
US

V. Phone/Fax

Practice location:
  • Phone: 914-800-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMAL ADDAGATLA
Title or Position: MANAGER
Credential: MD
Phone: 914-772-5874