Provider Demographics
NPI:1962522292
Name:NIRMALA M REDDY, MD
Entity type:Organization
Organization Name:NIRMALA M REDDY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIRMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:914-968-6935
Mailing Address - Street 1:207 SPRAIN RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1206
Mailing Address - Country:US
Mailing Address - Phone:914-968-6935
Mailing Address - Fax:914-231-5405
Practice Address - Street 1:970 N BROADWAY
Practice Address - Street 2:SUITE 309
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1309
Practice Address - Country:US
Practice Address - Phone:914-968-6935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167789A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01189211Medicaid
NYWEF681Medicare PIN
NY01189211Medicaid
NY48F811Medicare PIN