1265719355 NPI number — MR. ANANTHA R REDDY NURSE PRACTITIONER

Table of content: MR. ANANTHA R REDDY NURSE PRACTITIONER (NPI 1265719355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265719355 NPI number — MR. ANANTHA R REDDY NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
ANANTHA
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265719355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 EAST 194 STREET
Provider Second Line Business Mailing Address:
GROUND FLOOR
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10458-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-365-2603
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2527 VALENTINE AVE
Provider Second Line Business Practice Location Address:
3WA
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-365-2603
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F341186 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com