Healthcare Provider Details

I. General information

NPI: 1679148043
Provider Name (Legal Business Name): KOUSHIK VARMA SANGARAJU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATEN ISLAND UNIVERSITY HOSPITAL 475 SEAVIEW AVENUE
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

401 CHANDRA APARTMENT SAPTHAGIRI NAGAR A-CAMP
KUMOOL ANDHRA PRADESH
518002
IN

V. Phone/Fax

Practice location:
  • Phone: 718-226-8855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: