=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093927204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARIBANDI FAMILY PRACTICE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 471 HART ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11221-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-443-3800
-----------------------------------------------------
Fax | 718-443-3837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 SUPREME CT
-----------------------------------------------------
City | SMITHTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11787-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-443-3800
-----------------------------------------------------
Fax | 718-443-3837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAMAKRISHNA VEERA KARIBANDI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-443-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 182767
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------