Provider Demographics
NPI:1306662127
Name:BUDILI, MAHESWAR REDDY
Entity type:Individual
Prefix:
First Name:MAHESWAR
Middle Name:REDDY
Last Name:BUDILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ISRO DR
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1316
Mailing Address - Country:US
Mailing Address - Phone:201-912-6616
Mailing Address - Fax:
Practice Address - Street 1:5 ISRO DR
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1316
Practice Address - Country:US
Practice Address - Phone:201-912-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty