1972758787 NPI number — DR. SAM SUMAN NUTHALAPATY M.D

Table of content: DR. SAM SUMAN NUTHALAPATY M.D (NPI 1972758787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972758787 NPI number — DR. SAM SUMAN NUTHALAPATY M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUTHALAPATY
Provider First Name:
SAM
Provider Middle Name:
SUMAN
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:
1972758787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1217 AVALON SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN COVE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11542-2876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-427-6848
Provider Business Mailing Address Fax Number:
718-920-5180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E 233RD ST
Provider Second Line Business Practice Location Address:
MONTEFIORE MEDICAL CENTER NORTH DIVISION
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10466-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-920-9000
Provider Business Practice Location Address Fax Number:
718-920-9160
Provider Enumeration Date:
11/20/2008

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: 282N00000X , with the licence number:  131740114 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 258371 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 049139 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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