1710069158 NPI number — DR. RAMMOHAN GUMPENI M.D

Table of content: DR. RAMMOHAN GUMPENI M.D (NPI 1710069158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710069158 NPI number — DR. RAMMOHAN GUMPENI M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUMPENI
Provider First Name:
RAMMOHAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1710069158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7568 187TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESH MEADOWS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11366-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-670-1405
Provider Business Mailing Address Fax Number:
718-819-5388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5645 MAIN ST
Provider Second Line Business Practice Location Address:
#WA 100
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-5045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-670-1405
Provider Business Practice Location Address Fax Number:
718-461-2943
Provider Enumeration Date:
10/19/2006

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: 207RP1001X , with the licence number:  111523 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 111523-1 , 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)

  • Identifier: 061205476GU01 . This is a "FAMILY HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 124016 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5C6148 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11-3347168 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000106306 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0C048P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10209256 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4231839 . This is a "AETNA PPO / POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431637N . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: DS486 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000084001 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000197150101 . This is a "HEALTHPLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11P6421 . This is a "NYPRESBYTERIAN CHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160039 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00200793 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0074822 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100027142401 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 693961 . This is a "EMPIRE BC/BS" identifier . This identifiers is of the category "OTHER".




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