Provider Demographics
NPI:1306906938
Name:BHUMI, SRIDEVI (MD)
Entity type:Individual
Prefix:DR
First Name:SRIDEVI
Middle Name:
Last Name:BHUMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 QUAKER LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1320
Mailing Address - Country:US
Mailing Address - Phone:516-222-2727
Mailing Address - Fax:309-296-4929
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-222-2727
Practice Address - Fax:309-296-4929
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190757-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02216255Medicaid
NYH54109Medicare UPIN
NY4V4231Medicare ID - Type UnspecifiedMEDICARE