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NPI Code Detail

MEDICARE: PRADEEPA ARIVAZHAGAN MD

MEDICARE: PRADEEPA ARIVAZHAGAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianP100907NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P100907OTHERNYUNIVERSITY OF THE STATE OF NEW YORK, THE STATE EDUCATION DEPARTMENT

General Provider Information

NPI Number : 1518528603
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRADEEPA ARIVAZHAGAN MD
Provider Business Mailing Address
First Line : 4545 40TH ST APT 3R
Second Line :
City : SUNNYSIDE
State : NY
Zip : 11104-3919
Country : US
Telephone Number : 609-647-6038
Fax Number :
Provider Business Practice Location Address
First Line : 6995 QUEENS MIDTOWN EXPY
Second Line :
City : MASPETH
State : NY
Zip : 11378-1922
Country : US
Telephone Number : 609-647-6038
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2019
Last Update Date : 06/28/2019

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Directions to “ PRADEEPA ARIVAZHAGAN MD” Practice Location

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