1932171451 NPI number — MR. VINOD Y SOMAREDDY PT, DPT

Table of content: MR. VINOD Y SOMAREDDY PT, DPT (NPI 1932171451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932171451 NPI number — MR. VINOD Y SOMAREDDY PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOMAREDDY
Provider First Name:
VINOD
Provider Middle Name:
Y
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
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:
1932171451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 NORTHERN BLVD
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021-4802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-829-0030
Provider Business Mailing Address Fax Number:
516-466-7723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
GREAT NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11021-4802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-829-0030
Provider Business Practice Location Address Fax Number:
516-466-7723
Provider Enumeration Date:
02/07/2006

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: 225100000X , with the licence number:  023119-1 , 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: 02227741 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 168391 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2153187 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9442659 . This is a "CIGNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00000091742 . This is a "BETTERHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1961313 . This is a "FIRSTHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7619 . This is a "CAPITOL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 023119 . This is a "VYTRA HEALTHPLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 53885P . This is a "HIP HEALTHPLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2540752 . This is a "OXFORD HEALTHPLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QT1321 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 080023119NY03 . This is a "ANTHEM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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