Provider Demographics
NPI:1336739259
Name:VENKAT, SIVA (MD FRCSC)
Entity type:Individual
Prefix:
First Name:SIVA
Middle Name:
Last Name:VENKAT
Suffix:
Gender:M
Credentials:MD FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 EAST 68TH STREET, STARR 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5347
Mailing Address - Country:US
Mailing Address - Phone:646-508-0734
Mailing Address - Fax:
Practice Address - Street 1:525 EAST 68TH STREET, STARR 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-1006
Practice Address - Country:US
Practice Address - Phone:646-962-9600
Practice Address - Fax:646-962-0715
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ZZ17802208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program