1912017260 NPI number — NAGASIROMANI VENKATA KURAPATI MD

Table of content: NAGASIROMANI VENKATA KURAPATI MD (NPI 1912017260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912017260 NPI number — NAGASIROMANI VENKATA KURAPATI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURAPATI
Provider First Name:
NAGASIROMANI
Provider Middle Name:
VENKATA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KURAPATI
Provider Other First Name:
MANI
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912017260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4714 48TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11377-6550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-786-9595
Provider Business Mailing Address Fax Number:
718-786-9595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 NOTTINGHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-437-1280
Provider Business Practice Location Address Fax Number:
516-437-1280
Provider Enumeration Date:
08/30/2006

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: 208000000X , with the licence number:  150722 , 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: 00715297 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com