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General NPI Number Information
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NPI Number | 1356360382
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Entity Type | Organization
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Legal Business Name | CHENNAREDDY MD PC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 10105 LEFFERTS BLVD STE 203
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2014
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Country | US
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Telephone | 718-441-8086
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Fax | 718-250-6036
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Provider Business Mailing Address
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Address Line | 30 PURITAN AVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-6029
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Country | US
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Telephone | 718-250-8866
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Fax | 718-250-6703
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Authorized Official
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Title or Position | ADMINISTRATIVE SECRETARY
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Name | RAEFEAL NOAH LUKE
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Credential |
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Telephone | 646-883-0422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 112288
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License Number State | NY
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