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General NPI Number Information
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NPI Number | 1801842919
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Entity Type | Individual
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Provider Name | SAMPATH NEERUKONDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 476 CANISTEO ST
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City | HORNELL
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State | NY
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Zip | 14843-9768
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Country | US
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Telephone | 607-324-3580
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Fax | 607-324-3998
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Provider Business Mailing Address
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Address Line | 111 E 14TH ST
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City | ELMIRA
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State | NY
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Zip | 14903-1303
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Country | US
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Telephone | 607-734-9539
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Fax | 607-734-6293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 193861-1
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License Number State | NY
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